Bilateral Neonatal Adrenal Hemorrhage Associated With Severe Maternal COVID-19 Infection

Marcio José Concepción-Zavaleta,Kelly Meza,Anthony Ramos-Yataco,Sofia Pilar Ildefonso-Najarro,Luis Concepción-Urteaga,Julia Cristina Coronado Arroyo,Francisca Elena Zavaleta-Gutiérrez,Esteban Plasencia-Dueñas,Frederick Massucco Revoredo

doi:10.7759/cureus.20007

Abstract

Adrenal hemorrhage is the most common cause of adrenal mass in newborns. We present a case of a full-term male, born by cesarean section due to acute fetal distress from a mother with severe coronavirus disease 2019 (COVID-19) infection. He was diagnosed with hypoxic-ischemic encephalopathy, multifactorial shock, and early neonatal sepsis. On the seventh day of hospitalization, hemoglobin dropped and thus blood transfusion was required, and abdominal ultrasound showed bilateral adrenal hemorrhage. He developed relative adrenal insufficiency without either hemodynamic instability or electrolyte imbalances. The use of parenteral corticosteroids was not required. Follow-up ultrasonography and adrenal axis laboratory examination revealed complete resolution of adrenal hemorrhage. Neonatal adrenal hemorrhage has a wide variety of clinical manifestations. Ultrasound is preferred for both initial screening and follow-up evaluation. Adrenal insufficiency occurs rarely in neonatal adrenal hemorrhage. Treatment is usually conservative. We emphasize the importance of a timely diagnosis and clinical follow-up of adrenal hemorrhage in neonates with fetal distress born from mothers with severe COVID-19.

Highlights

Adrenal glands are relatively larger and more vascular early in life than in adulthood [1,2]
We present a case of a fullterm male, born by cesarean section due to acute fetal distress from a mother with severe coronavirus disease 2019 (COVID-19) infection
We emphasize the importance of a timely diagnosis and clinical follow-up of adrenal hemorrhage in neonates with fetal distress born from mothers with severe COVID-19

Summary

Introduction

Adrenal glands are relatively larger and more vascular early in life than in adulthood [1,2]. COVID-19 increases the rate of premature birth, fetal distress, and neonatal respiratory distress syndrome, these factors may contribute to the development of AH [7] In this manuscript, we present the case of a newborn with a bilateral adrenal hemorrhage who developed relative adrenal insufficiency and whose mother had a severe COVID-19 infection. A male infant was born at 39 weeks of gestation from a 31-year-old mother with three antenatal check-ups during pregnancy She presented to a primary care clinic with shortness of breath; her oxygen saturation was 90% on room exam. Due to laboratory findings and physical exam hypoxic-ischemic encephalopathy and multifactorial shock, early neonatal sepsis was diagnosed He was started on 3% sodium chloride, 10% dextrose, dopamine 8 ug/Kg/min, dobutamine 8 ug/Kg/min, sodium bicarbonate, calcium gluconate, phytomenadione, fresh frozen plasma, meropenem 80 mg intravenous every eight hours, and vancomycin 60 mg intravenous every eight due to abrupt clinical deterioration

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