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Updated: Sep 24, 2025
Transcutaneous Microcirculatory Imaging in Preterm Neonates
Published on: December 31, 2015
[Recurring genital bleeding in an extreme premature infant]
Franco Schettino O1, Julio Soto B2, Mónica Arancibia C2
1Facultad de Medicina, Universidad de Concepción, Concepción, Chile.
Insights
Exaggerated mini-puberty in extremely preterm infants can mimic precocious puberty and cause genital bleeding. Early recognition and conservative management are key for these complex cases.
Area of Science:
- Neonatology
- Pediatric Endocrinology
Background:
- Mini-puberty is a normal, transient activation of the hypothalamic-pituitary-gonadal axis in early infancy.
- Preterm infants may experience a more pronounced and extended mini-puberty phase.
Observation:
- A 25-week extremely preterm infant presented with signs of exaggerated mini-puberty at 5 months old.
- Clinical manifestations included breast buds, areolar pigmentation, vaginal estrogenic effects, and recurrent genital bleeding over three months.
Findings:
- Laboratory results revealed elevated luteinizing hormone (LH), follicle-stimulating hormone (FSH), and estradiol (E2).
- A diagnosis of exaggerated mini-puberty secondary to extreme prematurity was made, leading to a conservative management approach.
Implications:
- This case highlights that exaggerated mini-puberty in preterm infants can simulate precocious puberty and, exceptionally, cause genital bleeding.
- Understanding the clinical and laboratory spectrum of mini-puberty is crucial for appropriate management, especially with increasing survival rates of extremely premature infants.
Abstract:
Mini-puberty refers to the transient activation of the hypothalamic-pituitary-gonadal axis during the first months of life. This activation in preterm infants could be more exaggerated and prolonged. Ob jective: To present a case of exaggerated mini-puberty in an extremely preterm infant, with recurrent genital bleeding. Clinical Case: A 25-week preterm newborn presented at 5 months old with breast buds, areolar pigmentation, and estrogenic effects on the vaginal mucosa, with recurrent genital blee ding in three consecutive months. Her laboratory evaluation showed elevated values of luteinizing hormone (LH), follicle-stimulating hormone (FSH), and estradiol (E2). An exaggerated mini-puber ty due to extreme prematurity was suspected, therefore a conservative approach was taken. During follow-up, the patient showed partial regression of breast buds and cessation of genital bleeding, and decreasing levels of gonadotropin and estradiol. Conclusion: Mini-puberty in preterm newborns can present exaggeratedly, simulating precocious puberty and even presenting, exceptionally, recurrent genital bleeding. Considering the increasing survival of extremely premature infants, it is important to know the spectrum of clinical and laboratory manifestations of this phenomenon, in order to carry out adequate management.
