Does Urinary Tract Ultrasound have its Place in the Treatment of Early Neonatal Jaundice? Neonatal Bilateral Adrenal Hemorrhage: Case Report

Abstract

Adrenal hemorrhage is a rare clinical entity in the neonatal period, with an incidence of 1.7-2.1/1000 births. It is more often diagnosed on the right side, whilst bilateral hemorrhage occurs in 10%-15% of cases. Clinical presentation shows a wide range of symptoms, from the signs of adrenal insufficiency to asymptomatic course of illness with incidental finding of changes on testing. Neonatal jaundice due to hemolysis of hemorrhagic content often is an accompanying sign. We present a male neonate born at term, with early neonatal jaundice of unknown cause and without evidence of perinatal infection. Ultrasound of the urinary tract revealed hypoechoic formations in the upper poles of both kidneys, confirmed by magnetic resonance imaging of the abdomen. Clinical and laboratory test results showed no signs of adrenal insufficiency. There was no confirmation of embryonic tumor or neuroblastoma. Ultrasound of the urinary tract as an available and noninvasive test has its place in the treatment of early neonatal jaundice of unknown cause. Additional invasive treatment and unnecessary laparotomy can be avoided with ultrasound monitoring of the formation regression.

Keywords

• Adrenal gland diseases
• Hemorrhage
• Adrenal insufficiency
• Jaundice, neonatal
• Infant, newborn