Adrenal haemorrhage in neonates: risk factors and diagnostic and clinical procedure

Klinika Pediatrii i Endokrynologii, Akademia Medyczna, ul. Marszalkowska 24, Warszawa, Poland.
Medycyna wieku rozwojowego 01/2008; 12(1):457-62.
Source: PubMed


Prenatal and neonatal adrenal haemorrhage is being increasingly frequently reported. We present a group of 13 neonates with adrenal haemorrhage, hospitalised in the Department of Paediatrics and Endocrinology of Warsaw Medical University from 2003 to 2007.
of this study was to analyse: the perinatal history, haemorrhage predisposing factors, its size, localization and progress estimated by ultrasonography, as well as clinical, biochemical and hormonal findings indicating adrenal insufficiency.
the study group comprised 13 neonates hospitalised in the Department of Paediatrics and Endocrinology, Warsaw Medical University, from 2003 to 2007, due to adrenal haemorrhage diagnosed by ultrasonography in the first week of life.
all neonates were born at term, there was a male predominance. Twelve neonates had risk factors such as: birth trauma, intrauterine infection, perinatal asphyxia. No risk factors were found only in 1 neonate. One neonate had bilateral adrenal haemorrhage, others were unilateral - predominantly right-sided. In the study group clinical presentation was asymptomatic in 3 neonates, 1 of the patients had anaemia, 9 persistent jaundice, 2 bluish discoloration of the scrotum. Only one patient with bilateral adrenal haemorrhage showed sings of adrenal insufficiency and supplementation with glyco- and mineralcorticoids was necessary. Complete resolution of adrenal haemorrhage was reported after an average time of 3.5 months of observation.
1. Adrenal haemorrhage in neonates rarely leads to development of adrenal insufficiency. 2. In neonates with bilateral adrenal haemorrhage an extended hormonal diagnosis is required. 3. All patients require a systematic clinical and sonographic follow-up. Unilateral haemorrhage should be differentiated from neuroblastoma. 4. Scrotal haematoma may be a symptom of adrenal haemorrhage.

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    • "Because adrenal bleeding may remain asymptomatic, the real occurrence is probably higher [2]. Neonatal adrenal hemorrhage is frequently associated with birth trauma, perinatal asphyxia , intrauterine infection, coagulation defects and thromboembolism [1] [3]. Adrenal hemorrhage usually presents with neonatal jaundice, paleness and/or flank mass, discoloration of the scrotum, anemia and adrenal insufficiency [4] [5] [6]. "
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