NEONATAL ADRENAL HEMORRHAGE

Introduction: Adrenal hemorrhage is a rare condition in the neonatal period. The significant size of the adrenal gland and its particular hypervascularization are predisposing factors for bleeding, especially in cases of trauma or vascular thrombosis (of the renal vessels or the inferior vena cava). The aim of this study is to analyze the medical records to perform a descriptive study of neonates hospitalized in the Neonatology and Neonatal Resuscitation Department of CHU Hassan II in Fez.

Method:The cross-sectional study included all cases of neonates diagnosed with adrenal hemorrhage based on renal ultrasounds performed at the Neonatology and Neonatal Resuscitation Department of CHU Hassan II in Fez, between January 2016 and December 2023.

Result: Sixteen cases of adrenal hemorrhage were identified. The incidence of adrenal hemorrhage during the study period within the department was 2 per 1,000 hospitalizations. Both sexes are equally affected, with a male predominance of 62.5%. The two main reasons for hospitalization in our series were perinatal asphyxia and jaundice. Uterine expression was reported in 87.5% of cases. The most common clinical signs, in order of frequency, are: jaundice (56.25%), abdominal mass (50%), skin and mucous membrane pallor (31.25%), fever (31.25%), respiratory distress (31.25%), and fractures in 6.25% of cases. Severe hyperbilirubinemia was found in 3 patients, accounting for 18.75%. Anemia was found in 6 patients, or 37.5%. Adrenal insufficiency was observed in 3 cases, or 18.75%. Abdominal ultrasound was performed on all patients, revealing right adrenal hemorrhage in 8 cases, left in 5 cases, and bilateral in 3 cases. The outcome was favorable in 81.25% of cases, while 18.75% of patients died.

Conclusion: Adrenal hematoma is a rare condition in the neonatal period but can be severe, which justifies systematically searching for it in the presence of risk factors. Abdominal ultrasound is the key diagnostic test. The condition typically resolves spontaneously after several weeks.