Pediatric emergency medicine trisk 2561 2561

not uncommon and is thought to occur as a result of birth trauma. Clinical
manifestations depend on the degree of hemorrhage, and typically include signs
of anemia, and rarely adrenal insufficiency (poor feeding, vomiting, diarrhea,
obstipation, dehydration, irritability, hypoglycemia, uremia, and shock).
Treatment is largely supportive, and may include corticosteroids in the setting of
adrenal insufficiency. Rarely, surgical intervention for vessel ligation or
adrenalectomy is warranted. Neuroblastomas are the most common cause of
neonatal tumors, and occur most commonly in the adrenal gland. These can be
distinguished from adrenal hemorrhage based on US, and confirmed with urine
homovanillic acid (HVA) and vanillylmandelic acid (VMA) levels.
Pelvic Masses
Ovarian cysts can result from maternal hormonal stimulation in utero and often
are diagnosed in the fetal period, where the vast majority resolves prior to
delivery. For those that persist into the neonatal period, expectant management is
warranted as again most will resolve spontaneously. Large or complex cysts may
be at risk for torsion, which should be treated surgically. Additional
complications are rare but can include rupture with resultant hemoperitoneum or
bowel obstruction. Smaller cysts will typically resolve with expectant
management alone.

Genitourinary Anomalies
Goals of Treatment
Most genitourinary anomalies in the newborn are benign lesions or lesions that
can be monitored by the pediatrician in an outpatient setting. The goal of
treatment is to recognize the anomalies that require urgent evaluation and
treatment.
CLINICAL PEARLS AND PITFALLS
Vaginal discharge in the female neonate is typically benign, and
represents withdrawal of maternal hormones.
Patients with ambiguous genitalia, particularly infants with
masculinization of female-appearing genitalia, should be evaluated for

congenital adrenal hyperplasia, which can result in a life-threatening
adrenal crisis if untreated.
Circumcision