[Adrenal haemorrhage in neonates: risk factors and diagnostic and clinical procedure]. / Wylew do nadnerczy u noworodków: czynniki ryzyka i postepowanie diagnostyczno-kliniczne.

UNLABELLED: Prenatal and neonatal adrenal haemorrhage is being increasingly frequently reported. We present a group of 13 neonates with adrenal haemorrhage, hospitalised in the Department of Paediatrics and Endocrinology of Warsaw Medical University from 2003 to 2007. THE AIM: of this study was to analyse: the perinatal history, haemorrhage predisposing factors, its size, localization and progress estimated by ultrasonography, as well as clinical, biochemical and hormonal findings indicating adrenal insufficiency. MATERIAL AND METHODS: the study group comprised 13 neonates hospitalised in the Department of Paediatrics and Endocrinology, Warsaw Medical University, from 2003 to 2007, due to adrenal haemorrhage diagnosed by ultrasonography in the first week of life. RESULTS: all neonates were born at term, there was a male predominance. Twelve neonates had risk factors such as: birth trauma, intrauterine infection, perinatal asphyxia. No risk factors were found only in 1 neonate. One neonate had bilateral adrenal haemorrhage, others were unilateral - predominantly right-sided. In the study group clinical presentation was asymptomatic in 3 neonates, 1 of the patients had anaemia, 9 persistent jaundice, 2 bluish discoloration of the scrotum. Only one patient with bilateral adrenal haemorrhage showed sings of adrenal insufficiency and supplementation with glyco- and mineralcorticoids was necessary. Complete resolution of adrenal haemorrhage was reported after an average time of 3.5 months of observation. CONCLUSIONS: 1. Adrenal haemorrhage in neonates rarely leads to development of adrenal insufficiency. 2. In neonates with bilateral adrenal haemorrhage an extended hormonal diagnosis is required. 3. All patients require a systematic clinical and sonographic follow-up. Unilateral haemorrhage should be differentiated from neuroblastoma. 4. Scrotal haematoma may be a symptom of adrenal haemorrhage.

Determinants of the intima-media thickness in children and adolescents with chronic kidney disease.

The aim of the study was to evaluate changes in the arterial wall in children with chronic kidney disease (CKD). We studied 60 patients: 32 with stages 2-4 CKD [chronic renal failure (CRF)], 28 with stage 5 CKD [end-stage renal disease (ESRD)], and 43 controls (C). The evaluated parameters included intima-media thickness (IMT) of the carotid arteries, bone mineral density (BMD), serum lipid levels, and parameters of the calcium-phosphorus metabolism. Patients were divided into two groups: group 1 with normal arteries, and group 2 with arterial changes. The highest serum fetuin A level was found in group 1 compared with groups 2 and C. A negative correlation between IMT and fetuin A level was found. In patients with ESRD, a positive correlation of IMT with phosphorus level and age and a negative correlation with cyclase-activating parathyroid hormone and cyclase inhibiting parathyroid hormone (CAP/CIP) ratio was observed. Multiple linear regression showed that lower fetuin-A and alkaline phosphatase (AP) levels and higher lumbar spine BMD independently predicted higher IMT. Arterial wall changes in children with CKD were related to lower fetuin A and AP level and higher BMD. Low CAP/CIP and high phosphorus level may also be significant factors for arterial changes in patients with ESRD.