Recurring genital bleeding in an extreme premature infant

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 bleeding 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.