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Vaginal Bleeding in an Infant with Extreme Prematurity
Wing Yiu Sarah Poon1, Joanna Yuet Ling Tung1,2
1Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, The University of Hong Kong, NCB 115, 102 Pokfulam Rd, Pok Fu Lam, Hong Kong.
Case Reports in Pediatrics
|August 18, 2020
Summary
Minipuberty in premature infants can cause vaginal bleeding due to exaggerated hormone surges. This benign condition typically resolves on its own without intervention.
Area of Science:
- Pediatric Endocrinology
- Neonatology
- Reproductive Medicine
Background:
- Minipuberty involves transient activation of the hypothalamic-pituitary-gonadal (HPG) axis in early infancy.
- Preterm infants may experience a more pronounced and extended gonadotropin surge compared to full-term infants.
Observation:
- A case of minipuberty presenting with vaginal bleeding at 3 months corrected age in an extremely preterm infant (23+6 weeks gestation).
- Physical examination revealed bilateral breast buds, with hormonal investigations showing pubertal levels of LH, FSH, and estradiol.
Findings:
- The exaggerated gonadotropin surge in this extremely preterm infant led to endometrial maturation and vaginal bleeding.
- Hormonal levels and symptoms resolved spontaneously by 8 months corrected age, indicating a self-limiting process.
Implications:
- This case highlights that exaggerated minipuberty in preterm infants can manifest as vaginal bleeding.
- Pediatricians should recognize this as a benign, self-limiting phenomenon, avoiding unnecessary interventions.
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