Neonatal Adrenal Hemorrhage: A Case Series
Neonatal adrenal hemorrhage (NAH) in newborn infants is a rare event that is associated with specific anatomical and vascular characteristics. It is more common in term infants and occurs more often in neonates who feature perinatal asphyxia. Symptoms that more frequently prompt to diagnosis are prolonged jaundice, detection of an abdominal mass, anemia, scrotal discoloration and/or swelling, hypotonia, lethargy, and hypertension. However, NAH may also occur without symptoms with its detection being occasional. Imaging through ultrasound scans is the cornerstone of diagnosis and follow-up monitoring over time. Here we report on a small NAH case series comprising three full-term, macrosomic infants who were born by vaginal delivery. The first and second ones showed clear signs of birth asphyxia, whereas the third was completely asymptomatic. In all three patients, only the right adrenal gland was involved, in line with what happens in 70% of cases. NAH is usually self-limiting and prone to a progressive resolution in a time ranging between 3 weeks and 6 months and so did in our three patients.
NAH is caused by perinatal asphyxia.
It is diagnosed with addominal ultrasound.
It is usually self-limiting.
P.M., S.C., and E.T. conceived the work; P.M. supervised the case report collection, analyzed the data and revised the manuscript; E.T. and S.C. wrote the first draft of the manuscript, prepared the final version and submitted it; L.F., R.S., B.L., L.C., F.S., M.A.M., M.R.E., F.G., A.P. collected the data, followed-up with patients, reported outcomes, and gave inputs for the manuscript.
08 September 2020 (online)
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- 1 Mangurten HH. Birth injuries. In: Martin RJ, Fanaroff AA, Walsh MC. , eds. Fanaroff and Martin's Neonatal Perinatal Medicine-Diseases of the Fetus and Newborn. Philadelphia, PA: Mosby Elsevier; 2006: 529-559
- 2 Gyurkovits Z, Maróti Á, Rénes L, Németh G, Pál A, Orvos H. Adrenal haemorrhage in term neonates: a retrospective study from the period 2001-2013. J Matern Fetal Neonatal Med 2015; 28 (17) 2062-2065
- 3 Toti MS, Ghirri P, Bartoli A. , et al. Adrenal hemorrhage in newborn: how, when and why- from case report to literature review. Ital J Pediatr 2019; 45 (01) 58
- 4 Fedakar A. Adrenal hemorrhage in the neonatal intensive care unit: a four-year experience. Eur Respir J 2019; 5 (05) 816-821
- 5 Eo H, Kim JH, Jang KM. , et al. Comparison of clinico-radiological features between congenital cystic neuroblastoma and neonatal adrenal hemorrhagic pseudocyst. Korean J Radiol 2011; 12 (01) 52-58
- 6 Velaphi SC, Perlman JM. Neonatal adrenal hemorrhage: clinical and abdominal sonographic findings. Clin Pediatr (Phila) 2001; 40 (10) 545-548
- 7 Bhatt S, Ahmad M, Batra P, Tandon A, Roy S, Mandal S. Neonatal adrenal hemorrhage presenting as “Acute Scrotum”-looking beyond the obvious: a sonographic insight. J Ultrasound 2017; 20 (03) 253-259
- 8 Calisti A, Oriolo L, Molle P, Miele V, Spagnol L. Neonatal adrenal masses: do we have reliable criteria for differential diagnosis and expectant management?. Minerva Pediatr 2012; 64 (03) 313-318
- 9 Postek G, Streich H, Narębski K. Assessment of diagnostic methods in adrenal gland hemorrhage in neonates on the basis of own material from the years 2007-2011. Pol J Radiol 2011; 76 (03) 62-64