Adrenal hemorrhage in the neonatal intensive care unit: a four-year experience

Year 2019, Volume: 5 Issue: 5, 816 - 821, 04.09.2019

Atiye Fedakar

https://doi.org/10.18621/eurj.421168

Cited By: 3

Abstract

Objectives: Adrenal
hemorrhage is relatively uncommon and usually underestimated. This study aimed
to review the clinical, predisposing factors and ultrasonographic findings of adrenal hemorrhage newborns treated in hospital neonatal intensive care unit.

Methods: The
medical records of 14 newborns with adrenal
hemorrhage who had
been admitted to our neonatal intensive care unit were retrospectively
reviewed.

Results: During
the study period, 1979 patients were admitted to our neonatal intensive care
unit. Throughout the four-year follow-up of patients in the neonatal intensive
care unit, adrenal hemorrhage was diagnosed with ultrasonography
in 14 (0.70%) infants; thirteen of them were term babies, one of them was a
premature baby. Among these 14 patients, 10 (71.4%) were males, 4 (28.6%) were
females. The average birth weight was 3809.1 ± 358.5 g. Neonates
had risk factors such as: birth trauma in 5 (35.7%) newborns, perinatal
asphyxia in 4
(28.6%)
newborns, sepsis in
2 (14.3%) newborns, large
gestation age in 3 (21.4%) newborns. Resuscitation was performed in 7 (50%) infants in the delivery room. The most common clinical presentations
of the newborn with adrenal
hemorrhage
was hypotonia and lethargy (n = 5; 35.7%). Nine (64.3%) newborns had adrenal hemorrhage
on the right side, three (21.4%) of them had bilateral adrenal hemorrhage, and the last two (14.3%) had adrenal hemorrhage on left side. Resolution time of adrenal hemorrhage was a minimum of one month and
maximum of three months in ultrasonographic follow-up.

Conclusions: If there are
anamneses of strenuous and traumatic deliveries, and any clinical suspicion, ultrasonography should be performed to exclude adrenal hemorrhage,
since it is non-invasive, and also straightforward to apply. In babies with
hematomas that are increasing in size, adrenocorticotropic hormone and cortisol levels should be analyzed to prevent any
possible adrenal insufficiency, even if there is no clinical sign. 

Keywords

Adrenal hemorrhage, neonatal intensive care unit, traumatic delivery

References

• [1] Felc Z. Ultrasound in screening for neonatal adrenal hemorrhage. Am J Perinatol 1995;12:363-6.
• [2] 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, 8th ed., Philadelphia: Mosby Elsevier; 2006: pp.529-59.
• [3] Koplewitz BZ, Daneman A, Cutz E, Hellmann J. Neonatal adrenal congestion: a sonographic-pathologic correlation. Pediatr Radiol 1998;28:958-62.
• [4] Wang CH, Chen SJ, Yang LY, Tang RB. Neonatal adrenal hemorrhage presenting as a multiloculated cystic mass. .J Chin Med Assoc 2008;71:481-4.
• [5 ] Rumińska M, Welc-Dobies J, Lange M, Maciejewska J, Pyrzak B, Brzewski M. [Adrenal hemorrhage in neonates: risk factors and diagnostic and clinical procedure]. Med Wieku Rozwoj 2008;12:457-62. [Article in Polish]
• [6] Corcoran WJ, Strauss AA. Suprarenal hemorrhage in the newborn. JAMA 1924;82:626-30.
• [7] Schwärzler P, Bernard JP, Senat MV, Ville Y. Prenatal diagnosis of fetal adrenal masses: differentiation between hemorrhage and solid tumor by color Doppler sonography. Ultrasound Obstet Gynecol 1999;13:351-5.
• [8] Simon DR, Palese MA. Clinical update on the management of adrenal hemorrhage. Curr Urol Rep 2009;10.78-83.
• [9] Chang HY, Yeung CY, Hsu CH, Lee HC, Lee YJ, Lin D S, et al. Neonatal adrenal hemorrhage: four years’ experience. Clin Neonatol 2002;9:10-5.
• [10] Gunlemez A, Karadag A, Degirmencioglu H, Uras N, Turkay S. Management of severe hyperbilirubinemia in the newborn: adrenal hematoma revisited. J Perinatol 2005;25:803-4.
• [11] Demirel N, Baş AY, Zenciroğlu A, Taşci-Yildiz Y. Adrenal bleeding in neonates: report of 37 cases. Turk J Pediatr 2011;53:43-7.
• [12] Mutlu M, Karagüzel G, Aslan Y, Cansu A, Ökten A. Adrenal hemorrhage in newborns: a retrospective study. World J Pediatr 2011;7:355-7.
• [13] Avolio L, Fusillo M, Ferrari G, Chiara A, Bragheri R. Neonatal adrenal hemorrhage manifesting as acute scrotum:timely diagnosis prevents unnecessary surgery. Urology 2002;59:601.
• [14] Velaphi SC, Periman JM. Neonatal adrenal hemorrhage: clinical and abdominal sonografic finding. Clin Pediatr 2001;40:545-8.
• [15] Arayıcı S, Öncel MY, Sarı FN, Dizdar EA, Uraş N, Aycan Z, et al. A case of a newborn infant with adrenal insufficiency due to bilateral adrenal hemorrhage Turk J Pediatr 2011;57:102-4.
• [16] Khuri FJ, Alton DJ, Hardy BE, Cook GT, Churchill BM. Adrenal hemorrhage in neonates:Report of 5 cases and review of the literature. J Urology 1980;124:684-7.