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DOI: 10.1055/s-0029-1214239
Adrenal Hemorrhage in a Newborn
Publikationsverlauf
Publikationsdatum:
18. Mai 2009 (online)
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ABSTRACT
Sometimes in the course of care in a neonatal intensive care unit, there may be a rush to intervene in cases where limited intervention is actually the correct course. One such example is that of neonatal adrenal hemorrhage. We present the case of a male term neonate with shock, metabolic acidosis, distended abdomen, and falling hematocrit. His prenatal and delivery histories were uneventful except for a nuchal cord. Apgar scores were 9 and 9. Because of his dramatic presentation, certain members of the medical team suggested immediate surgical intervention. However, a calm and careful evaluation revealed the true diagnosis and course of action. Ultrasound of the abdomen showed a mass between the liver and kidney, but the origin was difficult to identify. A computed tomography scan supported the diagnosis of right adrenal hemorrhage. His serum cortisol level was normal. The patient was managed conservatively and discharged home after a 1-week stay in the hospital. Subsequent abdominal ultrasound showed resolving adrenal hemorrhage with minimal calcification. A review of the pertinent literature is presented. Physicians should remember adrenal hemorrhage when evaluating a newborn infant with shock, acidosis, abdominal distention, and falling hematocrit and that conservative management is usually indicated.
KEYWORDS
Adrenal hemorrhage - neonate - neonatal intensive care - abdominal mass - hypovolemia
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Arebu T AbduM.D.
Department of Pediatrics, Division of Neonatology, University of Kentucky College of Medicine
800 Rose St. MS 477, Lexington, KY 40536
eMail: abadtu2@uky.edu