- 期刊
Early Detection of Neonatal Adrenal Hemorrhage by Ultrasonography
以超音波術早期發現新生兒腎上腺出血
摘要
新生兒腎上腺出血並不罕見，主要是因其相對體積較大，且血流豐富。由於其臨床症狀可以由無症狀到出血性休克，因此新生兒腎上腺出血之罹患率各家報告不一。自從超音波發展出來以後，即使完全沒有症狀之新生兒腎上腺出血出會在新生兒腎臟篩檢時被發現。本篇研究之目的乃以超音波爲工具（一）探討本院嬰兒室其新生兒腎上腺出血之罹患率；（二）這些腎上腺出血嬰兒之臨床病程及預。結果吾人髮現自民國81年7月至民國82年7月至民國82年8月間共有15位新生兒腎上腺出血，罹患率約爲0.35%，比他人報告者爲低。患嬰之出生體重分佈爲3位低於3000公克，3位高於4000公克，9位高於4000公克，9位介於3000到4000公克。只有一位是早産兒，另一位是過熟兒，4位在生産史有新生兒窒息，只有一位在身體檢查時摸得到腹部腫塊。超音波所見爲11位在右側；2位在左側；2位是雙側。只有一位出生就見到腎上腺鈣化，表示在胎內即已發生腎上腺出血。沒有患嬰發生腎上腺皮質機能衰竭或續發性出血。2位以後的出現病理性黃疸，血清膽紅素超過16mg%，兩位有嚴重貧血現象。所有患嬰均經由保守治療，沒有患嬰發生腎上腺衰竭或其他嚴重併發症。故我們認爲超音波損傷簡單，是早期偵測新生兒腎上腺出血的最佳方法，且可對患嬰立即給予適當的治療及避免併發症的發生。
並列摘要
To investigate clinical features and course of neonatal adrenal hemorrhage (NAH) from July 1992 to August 1993, fifteen babies suffering from NAN born at Veterans General Hospital-Taipei were included. Portable ultrasound scanner was used for initial screening. The frequency of NAN was approximately 0.35% which is lower than other reports. The distribution of their birth weight was 3 cases lower than 3000 gm, 3 cases over 4000 gm and 9 cases within 3000 to 4000 gm. Only one was premature and another one post-term. Four of them had a history of either prenatal or perinatal asphyxia. Only one patient had a palpable abdominal mass. On the sonographic findings, eleven had bleeding in the right-side, two in the left-side and two in both sides. Only one had adrenal calcification. During their early life, no patient developed adrenal cortical insufficiency or secondary profuse bleeding. Two patients had pathologic jaundice. Two patients had severe anemia. After conservative treatment, none of them developed any severe complication. In conclusion, with the aid of renal sonoscreening in the newborn, we can discover NAN early and give adequate treatment at once. Severe complications also can be prevented.