Interpretation of screening for congenital adrenal hyperplasia in preterm infants

Chung, Hye Rim; Shin, Choong Ho; Yang, Sei Won; Yun, Kyong Ah; Lee, Young Ah; Park, So Eun; Choi, Chang Won; Kim, Byung Il; Choi, Jung Hwan; Song, Junghan

Original Article

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

정혜림^¹^, 신충호^¹^, 양세원^¹^, 윤경아^¹^, 이영아^¹^, 박소은^¹^, 최창원^¹^, 김병일^¹^, 최중환^¹^, 송정한^²

^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