A Case Report of an Extremely Low Birthweight Infant with Circulatory Collapse Accompanied by Cerebral Infarction after the Acute Period

ABSTRACT

A male infant (gestational age, 26 weeks and 1 day; birthweight, 752 g) was treated for respiratory distress syndrome and thereafter required mechanical ventilation due to chronic pulmonary insufficiency. On the 34th day after birth, urine volume suddenly decreased and hypotension, oliguria, and generalized edema developed. Laboratory studies revealed rapid progression of severe hyponatremia and hyperkalemia. Although hypovolemic shock was suspected, the patient did not respond to conventional treatment of volume expansion and inotropic support. Only treatment with glucocorticoids was effective. Two weeks later, cranial ultrasonography revealed multiple, right-sided, cystic lesions that were subsequently diagnosed as cerebral infarction by magnetic resonance imaging. Several cases of extremely low birthweight infants with circulatory collapse after the acute period have been described recently, but the cause has been unclear. There has been no previous report of a case accompanied by cerebral infarction.

KEYWORDS

Circulatory collapse - hyponatremia - cerebral infarction

REFERENCES

• 1 Helbock H J, Insoft R M, Conte F A. Glucocorticoid-responsive hypotension in extremely low birth weight newborns.  Pediatrics. 1993;  92 715-717
• 2 Ng P C, Lam C WK, Fok T F et al.. Refractory hypotension in preterm infants with adrenocortical insufficiency.  Arch Dis Child Fetal Neonatal Ed. 2001;  84 F122-F124
• 3 Colasurdo M A, Hanna C E, Gilhooly J T, Reynolds J W. Hydrocortisone replacement in extremely premature infants with cortisol insufficiency.  Clin Res. 1989;  37 180A
• 4 Ward M R, Kimura R E, Rich-Denson C. Addisonian crisis in extremely premature neonates.  Clin Res. 1991;  39 11A
• 5 Sulyok E, Varga F, Gyory E, Jobst K, Csaba I F. Postnatal development of renal sodium handling in premature infants.  J Pediatr. 1979;  95 787-792
• 6 Sulyok E, Nemeth M, Tenyi I et al.. Postnatal development of renin-angiotensin-aldosterone system, RAAS, in relation to electrolyte balance in premature infants.  Pediatr Res. 1979;  13 817-820
• 7 Huysman M W, Hokken-Koelega A C, De Ridder M A, Sauer P J. Adrenal function in sick very preterm infants.  Pediatr Res. 2000;  48 629-633
• 8 Rayson B M, Edelman I S. Glucocorticoid stimulation of Na-K-ATPase in superfused distal segments of kidney tubules in vitro.  Am J Physiol. 1982;  243 F463-F470
• 9 Miller V. Neonatal cerebral infarction.  Semin Pediatr Neurol. 2000;  7 278-288
• 10 De Vries L S, Groenendaal F, Eken P, van Haastert I C, Rademaker K J, Meiners L C. Infarcts in the vascular distribution of the middle cerebral artery in preterm and fullterm infants.  Neuropediatrics. 1997;  28 88-96
• 11 Volpe J J. Neurology of the Newborn, 4th ed. Philadelphia; WB Saunders 2001: 296-330