obsolete adrenal hemorrhage of fetus or newborn

Adrenal Hemorrhage in Fetus or Newborn: A Rare and Serious Condition

Adrenal hemorrhage in the fetus or newborn is a rare and serious condition that can have severe consequences if left untreated. It occurs when there is bleeding in the adrenal glands, which are two small glands located on top of each kidney.

Causes and Risk Factors

The exact cause of adrenal hemorrhage in the fetus or newborn is not always clear, but it is often associated with traumatic delivery, birth asphyxia, sepsis, coagulation disorders, and perinatal injuries [11]. In most cases, the right adrenal gland is affected (about 70% of cases), while bilateral involvement occurs only in about 10% of cases [11].

Symptoms and Presentation

The symptoms and presentation of adrenal hemorrhage can vary widely, ranging from asymptomatic newborns to life-threatening hypovolemic shock and adrenal crisis [5]. In some cases, the condition may be detected prenatally through ultrasound imaging, while in others, it may not be diagnosed until after birth.

Radiographic and Physical Findings

Adrenal hemorrhage can have radiographic and physical findings that are indistinguishable from adrenal neoplasms [13]. Some affected infants may have no identifiable risk factors, but a history of hypoxia during delivery, prolonged labor, obstetrical trauma, maternal shock, or sepsis can often be elicited [6, 7, 8].

Incidence and Prevalence

The incidence of adrenal hemorrhage in the fetus or

Prolonged Neonatal Jaundice: Adrenal hemorrhage in neonates can present as prolonged neonatal jaundice, which is a condition where the baby's bilirubin levels remain high for an extended period. This can be a sign that something is amiss with the baby's adrenal glands.

• Anaemia: Another possible symptom of adrenal hemorrhage in newborns is anaemia, which occurs when the baby doesn't have enough red blood cells to carry oxygen around their body.
• Scrotal Swelling: In some cases, adrenal hemorrhage can cause scrotal swelling, which is a condition where the skin on the scrotum becomes swollen and tender.
• Shock with Abdominal Distension: Adrenal hemorrhage can also lead to shock, which is a life-threatening condition that occurs when the baby's blood pressure drops suddenly. This can be accompanied by abdominal distension, which is a condition where the baby's abdomen becomes swollen and tender.

Classic Biochemical Signs

• Poor Feeding: Infants with adrenal hemorrhage may experience poor feeding, which means they don't want to eat or drink as much as usual.
• Decreased Alertness: Another possible symptom is decreased alertness, which means the baby seems less responsive than usual.
• Vomiting with Signs of Dehydration: Adrenal hemorrhage can also cause vomiting, which can lead to dehydration if not treated promptly.

References

1. [1] by SAO Hasan · 2017 · Cited by 1 — Adrenal haemorrhage in neonates can present as prolonged neonatal jaundice, anaemia, scrotal swelling, shock with abdominal distension, isolated hyperkalaemia ...
2. [4] Mar 1, 2015 — In infants, it can present as poor feeding, decreased alertness, and vomiting with signs of dehydration. Classic biochemical signs include ...

These symptoms are a result of the adrenal hemorrhage affecting the baby's adrenal glands, leading to an imbalance in their bodily functions. If you suspect that your newborn is experiencing any of these symptoms, please consult a medical professional for proper evaluation and treatment.

Diagnostic Tests for Adrenal Hemorrhage in Fetus or Newborn

Adrenal hemorrhage in the fetus or newborn can be challenging to diagnose, but various imaging modalities and laboratory tests can help confirm the condition. Here are some diagnostic tests that may be used:

• Ultrasound: Ultrasound is a non-invasive imaging modality that can detect adrenal hemorrhage in the fetus or newborn. It can show the presence of blood in the adrenal gland and surrounding tissues [3, 8].
• Color Doppler and Power Doppler ultrasound: These advanced ultrasound techniques can provide more detailed information

Treatment of Adrenal Hemorrhage in Fetus or Newborn

Adrenal hemorrhage in a fetus or newborn can be a serious condition, and prompt treatment is essential to prevent complications.

• Hydrocortisone Replacement: Infants with acute hemorrhage may require urgent replacement of blood and administration of vitamin K. Large doses of hydrocortisol should be given intravenously (IV) to replace the adrenal hormones [6][7].
• Corticosteroids: A single course of corticosteroids is recommended for pregnant women between 24 0/7 weeks and 33 6/7 weeks of gestation who are at risk of preterm delivery, which may help prevent adrenal hemorrhage in the fetus [9].

It's essential to note that prenatal therapy does not exist for adrenal hemorrhage. However, serial fetal surveillance can be performed to monitor fetal growth, changes in sonographic appearance, and other factors that may indicate an increased risk of adrenal hemorrhage [3].

Postnatal Treatment

After birth, treatment focuses on managing the symptoms and complications of adrenal hemorrhage.

• Hydrocortisone Replacement: Infants with adrenal hemorrhage may require hydrocortisone replacement to manage adrenal insufficiency. The dosage and duration of treatment will depend on the severity of the condition [6][7].
• Monitoring and Supportive Care: Close monitoring and supportive care are essential to prevent complications and ensure the infant's overall health.

It is crucial to consult with a healthcare professional for personalized guidance on treating adrenal hemorrhage in a fetus or newborn.

Differential Diagnoses for Adrenal Hemorrhage in Fetus or Newborn

Adrenal hemorrhage in the fetus or newborn is a relatively uncommon condition, and its diagnosis can be challenging due to nonspecific signs and symptoms. When considering differential diagnoses for adrenal hemorrhage, it's essential to consider various conditions that may mimic this condition.

Congenital Conditions:

• Fetal Neuroblastoma: A type of cancer that often presents with associated vascularity [4].
• Adrenal Cysts: Fluid-filled structures that can be found in the adrenal gland [6].

Neoplastic Conditions:

• Mesoblastic Nephroma: A rare kidney tumor that can present with symptoms similar to adrenal hemorrhage [2].

Infectious and Traumatic Conditions:

• Sepsis: A life-threatening condition caused by infection, which can lead to adrenal insufficiency [11].
• Traumatic Delivery: Physical trauma during birth can cause adrenal hemorrhage [10].

Other Differential Diagnoses:

• Pulmonary Sequestrations: Abnormal lung tissue that can present with symptoms similar to adrenal hemorrhage [5, 6].
• Adrenal Insufficiency: A condition caused by the underproduction of hormones by the adrenal gland, which can be life-threatening if left untreated [11].

Key Points:

• Adrenal hemorrhage is a relatively uncommon condition in the fetus or newborn.
• Differential diagnoses for adrenal hemorrhage include congenital conditions, neoplastic conditions, infectious and traumatic conditions, and other differential diagnoses.
• A high index of suspicion and an interprofessional approach are crucial for improving patient outcomes.

References:

[2] SI Shin. (2016). Suprarenal masses in neonates. [Cited by 13]

[4] Dec 12, 2022. Differential diagnosis. For a fetal adrenal mass consider: fetal neuroblastoma: often has associated vascularity.

[5] P Schwärzler. (1999). The differential diagnoses of fetal adrenal mass include adrenal hemorrhage, neuroblastoma, adrenal and cortical renal cysts, pulmonary sequestrations, ...

[6] by C Lee. (2024). Adrenal hemorrhage should be on the differential when an infant is born with clinical and laboratory signs of anemia with no obvious cause.

[10] 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.

[11] The clinical diagnosis of AH is challenging, as patients may be asymptomatic or have a nonspecific clinical presentation (e.g. abdominal pain, hypotension, confusion, fever, decreased hemoglobin level [by 1.5 g dl −1 or more]).