Ultrasound Screening of Neonatal Adrenal Hemorrhage

新生兒腎上腺出血之超音波篩檢

李明哲(Ming-Che Lee) ； 林隆煌(Lung-Huang Lin)

《Acta Paediatrica Taiwanica》 41卷6期 (2000/12) Pp. 327-330

https://doi.org/10.7097/APT.200012.0327

摘要

新生兒腎上腺出血由於大部分的病人幷無明顯之症狀，過去常被忽略。本文探討此病的臨床表現、超音波特徵及發生率。兩年間，共有3,273位新生兒率爲0.55%，男比女爲8比10，這與國外男生多於女生的報告幷不同。其中只有一例爲早産兒。病例中無人有新生兒窘迫，這亦不同於國外之前的報告。平均出生體重爲3,530公克，超出百分之七十的正常出生體重分佈。61%的病例幷無症狀。11%有非生理性黃疸，22%有餵食不良及嘔吐的情形，只有一病例有嚴重貧血幷須接受輸血。94.4%的病例公須保守治療，只有一病例接受腎上腺切除。總結：新生兒腎上腺出血可早期被超音波篩檢出來，且大部份的病例僅須接受保守療法。如此便可避免因延遲診斷所致不必要的開刀及嚴重的後遺症。

關鍵字

新生兒腎上腺出血 ； 超音波

並列摘要

Neonatal adrenal hemorrhage (NAH) is frequently overlooked because the majority of cases are asymptomatic. In this study, we investigated the clinical symptoms, echo graphic characteristics and incidence of NAH from January 1998 to December 1999 at Cathay General Hospital, Taipei, Taiwan. Among 3273 newborns who had ultrasound screening, 18 cases were diagnosed as having NAH. The incidence was 0.55% which was compatible with other reports. But there was a female predominance (10:8) which was different from previous reports. Only one premature baby was diagnosed with NAH. No patients had perinatal asphyxia, and this was different from other reports. The mean birth body weight was 3530 grams which was more than the 75(superscript th) percentile of normal term baby birth weight. Sixteen cases had right-sided NAH and two cases had left-sided NAH. Eleven cases (61%) within this study were asymptomatic. The incidence of pathologic jaundice was 11%. Four babies (22%) had poor oral feeding combined with vomiting. Only one had severe anemia for which blood transfusion was required. There were no cases of adrenocortical insufficancy in our study. Only one patient received adrenalectomy. In conclusion, NAH can be detected early by sonography and most cases require only supportive treatment. Thus, unnecessary surgery and severe complications due to delayed diagnosis can be avoided.

並列關鍵字

neonatal adrenal hemorrhage ； ultrasound screening