以早期黃疸表現之新生兒腎上腺出血：一病例報告

Neonatal Adrenal Hemorrhage Presenting as Early Jaundice: Report of One Case

由於新生兒腎上腺相對較大的體積及血流豐富，新生兒腎上腺出血的發生並不少見，其發生率約為1.7至1.9人／每千人活產新生兒。新生兒腎上腺出血的臨床表現差異很大，從無症狀至嚴重出血導致低血壓，休克，或腎上腺功能不全等皆有。超音波在診斷新生兒腎上腺出血及區分新生兒腎上腺腫瘤合併出血佔重要地位，腎上腺出血於超音波的追蹤檢查會顯示改變回音像及逐漸縮小而消失，進而可以避免不必要的外科手術。在此報告一位新生兒出生時有發紺及活動力降低但經刺激及給予氧氣後便改善，兩天大時黃疸值為20.3mg/dL，血紅素13.1gm/dL，血球比容38.6%，經照光治療6天後的黃疸值為11.4mg/dL，腹部超音波意外發現一左腎上方腫瘤，經電腦斷層掃描及追蹤超音波檢查顯示該腫瘤液化後逐漸縮小消失證實為左側腎上腺出血。

The neonatal adrenal gland is vulnerable to traumatic hemorrhage because of its relatively large size and hypervascularity. The clinical manifestations of neonatal adrenal hemorrhage (NAH) are variable. We present a case of NAH, with cyanosis and decreased activity soon after birth, but improved after tactile stimulation and oxygen supply. Marked jaundice with anemia was noted at 2 days of age. Abdominal ultrasound revealed a left suprarenal mass with mixed echogenicity. Total bilirubin level declined after 6 days of phototherapy. Progressive regression and complete resolution of the mass on follow-up ultrasonography comfirned the diagnosis of NAH.