Department of Neonatology, Toho University School of Medicine, Ota-ku, Tokyo, Japan.
Am J Perinatol. 2010 Jun;27(6):485-91. doi: 10.1055/s-0030-1247604. Epub 2010 Jan 29.
We investigated the postnatal pattern of changes in adrenal size in very low-birth-weight (VLBW) infants and its relation to late-onset glucocorticoid-responsive circulatory collapse (LGCC) that may be associated with adrenal insufficiency. In 36 VLBW infants born at <33 weeks' gestation, ultrasound examinations of postnatal changes in adrenal size during the first 3 weeks of life were performed. VLBW infants were classified into three groups: group A (N = 6), the actual adrenal area was greater than or equal to the predicted value at birth and unchanged at 3 weeks; group B (N = 24), the actual adrenal area was greater than or equal to the predicted value and decreased at 3 weeks; and group C (N = 6), the actual adrenal area was less than the predicted value and unchanged at 3 weeks. Five infants developed LGCC, and all five were in group A. These observations suggest that the life of the adrenal fetal zone might be extended beyond 3 weeks after birth in some VLBW infants and that prolonged fetal zone activity might correlate with LGCC. On the other hand, adrenal maturation might have already occurred at birth in some VLBW infants. Sonographic evaluation of adrenal size may enable prediction of subsequent LGCC in VLBW infants.
我们研究了极低出生体重（VLBW）婴儿出生后肾上腺大小变化的模式及其与可能与肾上腺功能不全相关的迟发性糖皮质激素反应性循环崩溃（LGCC）的关系。在 36 名出生于<33 周妊娠的 VLBW 婴儿中，在生命的前 3 周进行了超声检查以观察出生后肾上腺大小的变化。将 VLBW 婴儿分为三组：A 组（N=6），实际肾上腺面积在出生时大于或等于预测值，3 周时无变化；B 组（N=24），实际肾上腺面积大于或等于预测值且 3 周时减小；C 组（N=6），实际肾上腺面积小于预测值且 3 周时无变化。有 5 名婴儿发生 LGCC，且均在 A 组。这些观察结果表明，在某些 VLBW 婴儿中，肾上腺胎儿区的寿命可能在出生后 3 周后延长，并且延长的胎儿区活动可能与 LGCC 相关。另一方面，在一些 VLBW 婴儿中，肾上腺成熟可能已经在出生时发生。肾上腺大小的超声评估可能能够预测 VLBW 婴儿随后发生 LGCC。
