Background: Relative adrenal insufficiency (RAI) may be associated with neonatal adrenal hemorrhage (AH).
Objective and hypotheses: The purpose of this study was to investigate the usefulness of ultrasonography for detecting AH in steroid treated neonates with RAI.
Method: A retrospective analysis of 52 corticosteroid-treated patients with RAI at a neonatal intensive care unit of a tertiary center from January 2006 to April 2014 was performed to assess for the prevalence of adrenal hemorrhage and to identify factors associated with RAI. In addition, 17 patients who had been diagnosed with AH from January 2000 to June 2014 were investigated retrospectively to examine the clinical characteristics of the patients.
Results: The median gestational age of the 52 patients with RAI was 27+2 weeks and their median birth weight was 878 g. The basal cortisol levels before and after corticosteroid treatment were 6.2 and 8.0 μg/dl, respectively. Ultrasonography was performed for the 52 patients and none showed evidence of adrenal hemorrhage. For those 17 patients who had been diagnosed with AH, 15 were born full term while two were born premature. Four of the 17 patients were large for gestational age. The reasons for the initial abdominal ultrasonography were septicemia (n=7), sacral dimple and single umbilical artery (n=1), abnormal prenatal ultrasound with suspected adrenal mass (n=7), and acute scrotum (n=1). Sixteen patients had unilateral AH of which 14 were right sided. Only one patient with associated sepsis, jaundice, anemia, and thrombocytopenia had bilateral AH and also showed signs of adrenal insufficiency requiring steroid treatment.
Conclusion: Abdominal ultrasonography is not necessary for the detection of adrenal hemorrhage in corticosteroid treated neonates. However, adrenal function and ultrasonographic evaluation may be required in those neonates with septicemia, severe anaemia, prolonged jaundice, and/or thrombocytopenia.
01 - 03 Oct 2015
European Society for Paediatric Endocrinology