ESPE Abstracts

Introduction: Mini-puberty is defined as the transient activation of the hypothalamic-pituitary-gonadal (HPG) axis during the first 3-6 months of life. Postnatal HPG activation occurs more robustly and for a longer duration in premature infants compared to term infants. In this report, we present a case of severely premature infant who presented with vaginal bleeding during the mini-puberty period.

Case: A 5-month and 12-day-old female infant (corrected age 2 months) presented with blood observed in her diaper. The infant was born at 24^6/7 weeks gestation due to preeclampsia, with a birth weight of 580 grams. She had received treatment in the neonatal intensive care unit for 5 months due to respiratory, cardiac and feeding issues. Her medical history included bronchopulmonary dysplasia, retinopathy of prematurity, patent ductus arteriosus, patent foramen ovale and she was requiring intermittent oxygen support via mask. On physical examination, her length: 50 cm(-2.55 SDS), body weight: 3500 grams(-2.09 SDS) and head circumference: 34 cm(-3.68 SDS). She exhibited pubarche stage 1 and bilateral thelarche stage 3, with estrogen effects in the vaginal mucosa. Laboratory tests revealed LH: 3.8 IU/L, FSH: 6.32 IU/L and Estradiol: 66.7 ng/L. Pelvic ultrasonography demonstrated a uterus measuring 19*12*35 mm with an endometrial thickness of 3.5 mm, a defect in the left anterior abdominal wall with the left ovary located in the inguinal region, multiple follicles in both ovaries and a functional cyst measuring 18*14 mm in the right ovary. During follow-up, the infant experienced spotting and discharge on her diaper for 5 days, but her overall condition remained stable. As the bleeding decreased, the patient underwent surgery for left inguinal hernia and the inguinally located ovary. During follow-up, intermittent vaginal discharge was reported for 2 months. At the last follow-up, at 9 months and 12 days old (corrected age 6 months), the patient had no recurrent vaginal bleeding. Physical examination showed no pubarche, bilateral thelarche stage 2 and her gonadotropin levels were low, reflecting a prepubertal state.

Conclusion: In the differential diagnosis of uterine bleeding in girls during the first 6 months of life, infantile mini-puberty should be considered. Studies have shown that premature infants exhibit an exaggerated gonadotropin surge compared to term infants. Our case demonstrates that in a severely premature infant, the significant increase in gonadotropins during the mini-puberty period can lead to endometrial thickening and vaginal bleeding.

Keywords: Mini-puberty, premature, vaginal bleeding