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A Clinical Study and Sonographic Findings of Neonatal Adrenal Hemorrhage

Korean Journal of Pediatrics 2004;47(5):535-542.
Published online May 15, 2004.
A Clinical Study and Sonographic Findings of Neonatal Adrenal Hemorrhage
Ok Yeon Cho1, Kyoung Eun Lee1, Eun Jung Shim1, Do Jun Cho1, Dug Ha Kim1, Ki Sik Min1, Ki Yang Yoo1, Kwan Sub Lee2
1Department of Pediatrics, College of Medicine, Hallym University, Chunchon, Korea
2Department of Radiology, College of Medicine, Hallym University, Chunchon, Korea
신생아 부신 출혈의 임상적 고찰과 초음파 소견
조옥연1, 이경은1, 심은정1, 조도준1, 김덕하1, 민기식1, 유기양1, 이관섭2
1한림대학교 의과대학 소아과학교실
2한림대학교 의과대학 진단방사선과학교실
Correspondence: 
Dug Ha Kim, Email: dougkim@hallym.or.kr
Abstract
Purpose
: This study was performed to present out experience of neonatal adrenal hemorrhage (NAH) and to help diagnosis and management of NAH.
Methods
: We conducted a retrospective study on 14 neonates diagnosed as NAH from January 1993 to August 2002 at Hallym Medical Center. Their clinical manifestations, risk factors, sonographic findings and progression of NAH were evaluated using medical records.
Results
: There were 12 male cases and two female cases. All cases were full-term babies. In terms of method of delivery, there were 13 cases of vaginal delivery and one case of cesarean section. The most common symptom was jaundice(10 cases). Poor feeding, vomiting, anemia, scrotal swelling with bluish discoloration, abdominal distension and cyanosis were also noted. The risk factors included perinatal asphyxia(five cases), large baby(three cases), sepsis(one case) and birth trauma(one case). Twelve cases(85.7%) involved the right adrenal gland, one case(7.1%) the left side and one case(7.1%) bilateral. In abdominal sonography, hemorrhage was seen as an isoechoic mass with central anechoic portion(35.7%), a central hypoechoic mass with peripheral hyperechoic portion(28.6 %), an anechoic cystic mass(28.6%) and a heterogeneous hyperechoic mass(7.1%). Only a conservative treatment was sufficient in all cases. In the 12 cases(85.7%) followed up, size of hemorrhage was reduced in repetitive sonography without any complications.
Conclusion
: The review of these patients emphasizes the subtle and diverse clinical presentation of adrenal hemorrhage in neonates and stresses the importance of repetitive abdominal sonography in establishing the diagnosis.
Key Words: Neonatal adrenal hemorrhage


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