Neonatal adrenal hemorrhage (draft of clinical recommendations)

  • D.O. Ivanov Saint Petersburg State Pediatric Medical University. 2 Lithuania, Saint Petersburg 194100 Russian Federation
  • A.S. Panchenko Saint Petersburg State Pediatric Medical University. 2 Lithuania, Saint Petersburg 194100 Russian Federation
  • E.N. Balashova Research Center for Obstetrics, Gynecology and Perinatology, Moscow, Russia
  • T.V. Belousova Novosibirsk State Medical University, Novosibirsk, Russia
  • E.V. Bem Saint Petersburg State Pediatric Medical University. 2 Lithuania, Saint Petersburg 194100 Russian Federation
  • D.S. Dodrov Ekaterinburg Clinical Perinatal Center, Ekaterinburg, Russia
  • N.M. Zelenin Saint Petersburg State Pediatric Medical University. 2 Lithuania, Saint Petersburg 194100 Russian Federation
  • O.L. Ksenofontova Ekaterinburg Clinical Perinatal Center, Ekaterinburg, Russia
  • M.I. Levadneva Saint Petersburg State Pediatric Medical University. 2 Lithuania, Saint Petersburg 194100 Russian Federation
  • I.V. Myznikova Saint Petersburg State Pediatric Medical University. 2 Lithuania, Saint Petersburg 194100 Russian Federation
  • S.E. Pavlova Saint Petersburg State Pediatric Medical University. 2 Lithuania, Saint Petersburg 194100 Russian Federation
  • E.V. Plotnikova Saint Petersburg State Pediatric Medical University. 2 Lithuania, Saint Petersburg 194100 Russian Federation
  • L.A. Romanova Saint Petersburg State Pediatric Medical University. 2 Lithuania, Saint Petersburg 194100 Russian Federation
  • Yu.L. Skorodok Saint Petersburg State Pediatric Medical University. 2 Lithuania, Saint Petersburg 194100 Russian Federation
  • G.N. Chumakova Saint Petersburg State Pediatric Medical University. 2 Lithuania, Saint Petersburg 194100 Russian Federation
  • L.A. Fedorova Saint Petersburg State Pediatric Medical University. 2 Lithuania, Saint Petersburg 194100 Russian Federation
  • E.V. Shestak Ekaterinburg Clinical Perinatal Center, Ekaterinburg, Russia
Keywords: neonatal adrenal hemorrhage, newborns, acute adrenal insufficiency in newborns

Abstract

Adrenal hemorrhage (AH) in a newborn is a relatively rare pathological condition (0.2 to 3.0%) that occurs in the early neonatal period and is the most common adrenal formation. Damage to the right adrenal gland occurs more often due to the peculiarities of its anatomical location between the liver and the spine. Neonatal AH can lead to partial or complete loss of hormonal function of the organ. In most cases, adrenal gland damage in newborns develops secondarily against the background of the underlying disease; in some cases, the cause of hemorrhage cannot be determined. The most common risk factors are traumatic birth, macrosomia, hypoxia, arterial hypotension, coagulopathy, sepsis, and tumor. Early diagnostics of AH is difficult, since clinical symptoms of AH in most cases are absent or non-specific: intense jaundice, anemia, a palpable painful formation in the abdominal cavity with massive bleeding, possible edema and cyanotic discoloration of the scrotum with rupture of the adrenal capsule. In severe cases, AH may manifest itself with symptoms of adrenal insufficiency, hypovolemic shock, and even death is possible. Isolated AH in a newborn usually does not require medical or surgical treatment and is characterized by regression of symptoms within 12 weeks or more. Newborns who have experienced AH remain at risk of developing chronic adrenal insufficiency. The main method of preventing AH is to reduce the trauma of the birth process, choosing the most gentle tactics of delivery, based on the characteristics of each individual clinical situation.

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Published
2025-07-08
Section
EDITORIAL