Bilateral Neonatal Adrenal Hemorrhage Presenting as Early-onset Anemia: A Diagnostic Challenge

Early-onset anemia in neonates presents a diagnostic challenge requiring a systematic approach to identify underlying causes. We report a case of a term infant who developed significant anemia within the first 48 h of life, ultimately diagnosed with bilateral neonatal adrenal hemorrhage (NAH). Initial laboratory evaluation showed features of acute hemolysis, but peripheral blood film (PBF) was not consistent. The presence of bilateral flank masses on examination prompted urgent ultrasonography, which confirmed adrenal hemorrhage. NAH is a rare but important cause of neonatal anemia and can be challenging to diagnose due to its overlapping clinical features and laboratory parameters with other more common causes. This case underscores the need for a structured approach, incorporating hematological parameters, imaging, and clinical examination to distinguish them. Point-of-care and serial ultrasonography play a pivotal role in the diagnosis and differentiation of NAH from other suprarenal masses, ensuring appropriate and timely management.