An unusual presentation of a birth trauma in a newborn: A case report

A term, male infant weighing 4.725 kg, was born vaginally to a grand multipara, diabetic mother. The birth was difficult and needed assistance with ventose. At 48 hours of birth, the infant noted to be febrile (temperature of 38.5C) with dry skin. Shortly after that, he developed vomiting, loose motions, irritability, and seizure. Examination revealed a macrosomic, normotensive infant, with slightly prolonged capillary refill time (3 sec), clear lung fields, normal heart sounds, bilaterally palpable renal masses which was ovoid, smooth, and 10 × 5 cm in size. Other systems were normal including normal male genitalia. Investigations were normal, apart from hypoglycaemia (random blood sugar of 48 mg/dl), hyponatraemia (Na = 129 mmol/l), and hyperkalaemia (K = 6.7 mmol/l). A salt loosing congenital adrenal hyperplasia was suspected and the abdominal ultrasound (U/S) scanning showed isolated bilateral adrenal haemorrhage. The infant started on hydrocortisone and fludrocortisone. In conclusion, we here report an isolated adrenal haemorrhage that caused adrenal insufficiency in an infant of diabetic mother.