Adrenal hemorrhage in newborn: how, when and why- from case report to literature review

M S Toti,C Caputo,E Laudani,A Bartoli,R Bernardini,P Ghirri,L Mele,F Masoni

doi:10.1186/s13052-019-0651-9

M S Toti, C Caputo + Show 6 more

Open Access

https://doi.org/10.1186/s13052-019-0651-9

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Abstract

BackgroundNeonatal adrenal hemorrhage is a relatively uncommon condition (0.2–0.55%). Various risk factors have been reported in addition to birth asphyxia, such as sepsis, coagulation disorders, traumatic delivery, and perinatal injuries. Adrenal hemorrhage usually affects the right adrenal gland (about 70% of cases) while it involves the bilateral adrenal gland only in 10% of cases. In most cases, the event is asymptomatic but, in others, it may be so devastating to determine death by bleeding or adrenal insufficiency.Case presentationA case of bilateral neonatal adrenal hemorrhage, with adrenal insufficiency, but with no important risk factors and favorable evolution in a male infant.ConclusionsThis case emphasizes the importance of keeping a non-interventional attitude, avoiding early surgery but carrying out a serial sonographic follow-up. Serial ultrasound monitoring is the most reliable approach during conservative management.

Highlights

ConclusionsThis case emphasizes the importance of keeping a non-interventional attitude, avoiding early surgery but carrying out a serial sonographic follow-up
Neonatal adrenal hemorrhage is a relatively uncommon condition (0.2–0.55%)
Various risk factors have been reported in addition to birth asphyxia, such as sepsis, coagulation disorders, traumatic delivery, and perinatal injuries

Summary

Conclusions

NAH should be suspected even in the absence of important risk factors. In most cases, the event is asymptomatic but it could prove detrimental to determine death by bleeding or adrenal insufficiency. Once established the negativity of the cultures and the absence of risk factors for early-onset sepsis, the CRP increase and the poor clinical conditions in the first day of life may be referred to the unlucky hemorrhagic event. Long-term hydrocortisone therapy should not lead to a serious suppressive effect on the later function of the HPA axis. It is recommended a rapid suspension of this therapy with clinical or ultrasound improvement. In this case, it is evident that the first sonographic images showed signs of hemorrhage that occurred previously with an inhomogeneous aspect and an internal echoes such as a progression of hemoglobin changes.

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