Adrenal Hematoma in Newborns: What to do?

Abstract

Purpose: The adrenal gland is vulnerable to hemorrhage in the neonatal period because of its large size and its increased vascularity. The clinical manifestations are variable and non-specific. The aim of our work is to describe the clinical aspects, evolution and management of adrenal hemorrhage in the neonatal period.
Methodology: This report is based on a presentation of a newborn with an adrenal hematoma who was hospitalized in our neonatology unit.
Findings: The patient is a three-day old newborn female admitted in a state of shock. The anamnesis does not find any particular antecedent in antenatal or perinatal except an early rupture of membrane for more than 6 hours. The newborn was urgently transfused with phenotyped red blood cells and an antibiotic therapy was prescribed. The abdominal ultrasound showed a right adrenal hematoma measuring 42mm x 33mm.
Unique Contribution to Theory, Policy and Practice: The clinical manifestations of adrenal hemorrhage depend on the severity of the hemorrhage and the extent of which the adrenal cortex is involved. In extreme cases, the newborn can present a hypovolemic shock, as shown in our observation, requiring an emergency blood transfusion. Acute adrenal insufficiency is rarely reported in adrenal hemorrhage because the bleeding is mainly subcapsular and hormonal insufficiency does not occur below 90% of adrenal tissue damage.