Adrenal haemorrhage in term neonates: a retrospective study from the period 2001–2013

Abstract

Objective: To assess the incidence, risk factors and clinical presentations of neonatal adrenal haemorrhage (NAH) in uncomplicated, singleton and term deliveries. Methods: A retrospective analysis of 26 416 term neonates delivered between 2001 and 2013, and screened with abdominal ultrasonography. Results: Of the 26 416 neonates, 74 (0.28%) displayed NAH; the male/female ratio was 1.55:1. Vaginal delivery was significantly more frequent than caesarean section among them (71 versus 3; 95.9% versus 4.1%). Unilateral bleeding occurred on the right side in 36 (48.7%), and on the left in 34 (45.9%), without a significant difference; bilateral haematomas were found in four cases (5.4%). The most common risk factors were macrosomia (16, 21.6%) and fetal acidaemia (23, 31%), while four (5.4%) neonates exhibited pathological acidaemia. Clinical presentations included jaundice in 37 (50%), anaemia in six (8.1%) and an adrenal insufficiency in only one (1.3%) case. In three cases, neuroblastoma was diagnosed. Conclusions: Vaginal delivery, macrosomia and fetal acidaemia are the most important risk factors for NAH. The adrenal glands on both sides were similarly involved. In the healthy neonates with NAH, the clinical presentations were mild, with spontaneous regression. Differentiation of NAH from tumours is of considerable importance.

Adrenal haemorrhage in the new born: revisited

“…However, persistent neonatal jaundice, flank mass, scrotal swelling and haematuria, anaemia, hypo or hypertension, cyanosis, urinary tract infections and may be adrenal insufficiency with shock. The most common presentation includes neonatal jaundice, due to the breakdown of red blood cells in the hematoma [1,[5][6][7][15][16][17][18][21][22][23][24][25][26][27][28][29][30][31]. The nature of adrenal haemorrhage, in this series was bilateral.…”

“…This is highly vascular supply drains into medullary sinusoids via relatively few venous channels, thereby creating a potential vascular damage. Any condition leading to reduce oxygen supply (hypoxia) may lead to shunting of blood flow, and damage to endothelial making them more prone to haemorrhage, an example of this is congenital adrenal hyperplasia [1][2][3][16][17][18][19][20][21][22][23][24][25][26][27][28][29]. The most important predisposing cause of AH were birth trauma, prolonged labour, intrauterine infections, perinatal asphyxia or hypoxia, large birth weight, septicaemia, and haemorrhagic disorders.…”

Neonatal Adrenal Hemorrhage: A Case Series

“…4 NAH is more common in term infants, and is associated with vaginal delivery, macrosomia, fetal acidemia, hypoxia, birth asphyxia, sepsis, coagulation disorders, hypothrombinemia, prolonged labor, traumatic delivery, and perinatal injuries. 2 All three infants reported here were macrosomic and born at term by vaginal delivery. The first and second ones showed clear signs of birth asphyxia due to a difficult and traumatic birth, whereas the third one was completely asymptomatic at birth.…”

Bilateral adrenal hemorrhage in a neonatal kidney donor

“…AH is not infrequent in neonates suffering fetal distress during difficult labor with perinatal hypoxia . An association between AH and RVT has been reported.…”