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Interpretation of screening for congenital adrenal hyperplasia in preterm infants

Korean Journal of Pediatrics 2008;51(6):616-621.
Published online June 15, 2008.
Interpretation of screening for congenital adrenal hyperplasia in preterm infants
Hye Rim Chung1, Choong Ho Shin1, Sei Won Yang1, Kyong Ah Yun1, Young Ah Lee1, So Eun Park1, Chang Won Choi1, Byung Il Kim1, Jung Hwan Choi1, Junghan Song2
1Department of Pediatrics, Seoul National University, College of Medicine, Seoul, Korea
2Department of Laboratory Medicine, Seoul National University, College of Medicine, Seoul, Korea
미숙아에서의 선천 부신 과형성에 대한 선별검사의 해석
정혜림1, 신충호1, 양세원1, 윤경아1, 이영아1, 박소은1, 최창원1, 김병일1, 최중환1, 송정한2
1서울대학교 의과대학 소아과학교실
2서울대학교 의과대학 검사의학교실
Correspondence: 
Choong Ho Shin, Email: chshinpd@snu.ac.kr
Abstract
Purpose
: This study was undertaken to identify factors that influence 17-OHP levels in preterm infants and to suggest a reasonable follow-up schedule of screening for congenital adrenal hyperplasia (CAH) in preterm infants.
Methods
: The 17-OHP concentrations in filter paper blood spots of 427 preterm infants were obtained. The effects of gestational age (GA), systemic diseases, and antenatal dexamethasone on screening and follow-up 17-OHP values were investigated.
Results
: The screening 17-OHP values were markedly variable (range: 0.1-143.3 ng/mL). The screening 17-OHP levels were negatively correlated with GA (r=-0.535, P<0.01). In infants with GA <32 weeks, the screening 17-OHP levels were significantly higher in sick infants or infant with hypotension than in healthy infants. The screening values of prenatal dexamethasone-treated infants had a tendency to be low. In infants with initial 17-OHP values 20 ng/mL, the intervals until rescreening 17-OHP <10 ng/mL or serum 17-OHP <20 ng/mL were negatively correlated with GA (r=-0.541, P<0.01) and were prolonged in infants with bronchopulmonary dysplasia (P<0.01). None of the preterm infants were confirmatively diagnosed with CAH.
Conclusion
: The 17-OHP values of preterm infants were influenced by GA, prenatal dexamethasone, and postnatal diseases. Because the 17-OHP values of preterm infants were markedly variable, a follow-up schedule should be developed considering both 17-OHP values and clinical status.
Key Words: Congenital adrenal hyperplasia, Preterm, Neonatal screening


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