title: Late-onset circulatory dysfunction of premature infants and late-onset periventricular leukomalacia.
abstract: BACKGROUND
  The sudden appearance of hypotension and oliguria without obvious cause following stable circulation and respiration in preterm infants is frequent in Japan. Such episodes are referred to as late-onset circulatory dysfunction of premature infants (LCD). Volume expanders and inotropic agents are often ineffective against this condition, whereas i.v. steroids are significantly effective. A major problem is that cystic periventricular leukomalacia (PVL) often develops a few weeks after an episode. The aim of the present study was to clarify the risk factors, including LCD, related to cystic PVL.
  
  
  METHODS
  A case-control study was performed for preterm infants who were delivered at <33 weeks of gestation and admitted to seven neonatal intensive care units in Japan. Cystic PVL infants were stratified into early-onset PVL diagnosed within 28 days of age and late-onset PVL diagnosed after more than 28 days of age. The reported and new risk factors for PVL, for each group of PVL infants, and for all PVL infants, were compared with controls.
  
  
  RESULTS
  Thirty-two infants were diagnosed with cystic PVL (17 early-onset and 15 late-onset). All PVL infants significantly differed from controls on Apgar score, number of abortions and pregnancies, intraventricular hemorrhage, and LCD. LCD was diagnosed in 28.1% of both PVL groups compared with 6.3% of controls (P = 0.02). Multivariate analysis demonstrated significant association between late-onset PVL and LCD.
  
  
  CONCLUSIONS
  LCD was significantly associated with cystic PVL, especially late-onset PVL. Elucidating the cause of LCD might reduce the incidence of PVL and improve the neurological prognosis of preterm infants.
authors: Department of Pediatrics and Neonatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan. skoba@med.nagoya-cu.ac.jp
authors: Satoru
authors: S
authors: Kobayashi
authors: Shinji
authors: S
authors: Fujimoto
authors: Norihisa
authors: N
authors: Koyama
authors: Sumio
authors: S
authors: Fukuda
authors: Toshimitsu
authors: T
authors: Iwaki
authors: Taihei
authors: T
authors: Tanaka
authors: Minoru
authors: M
authors: Kokubo
authors: Shigeru
authors: S
authors: Ohki
authors: Tohru
authors: T
authors: Okanishi
authors: Hajime
authors: H
authors: Togari
mesh_terms: D000367:Age Factors; D001034:Apgar Score; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007022:Hypotension / Q000150:complications*; D007231:Infant, Newborn; D007234:Infant, Premature; D007969:Leukomalacia, Periventricular / Q000453:epidemiology*; D008297:Male; D009846:Oliguria / Q000150:complications*; D012307:Risk Factors