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Neonatal Emergencies: Abdominal Masses
Neonatal Emergencies: Abdominal Masses
emergencies
Abdominal masses
Classification: Depending on their location in the abdomen and ultrasound characteristics.
Treatment: etiological for each disease entity.
Anuria, oligoanuria, and abnormal voiding
The normal urinary excretion of a newborn is 1‐2 mL/kg/h, with the first urination
usually occurring within the first 12‐24 hours (93%).
It is considered to be pathological when there is no voiding within 48 hours or if there is
oligoanuria or the urinary stream is very weak.
Criteria of neonatal ARF
Anuria
Oliguria (<0.5 mL/kg/h)
BUN (>20 mg/dL)
increased +/‐ creatinine levels
Etiology of oligoanuria/neonatal anuria
Associated with RF Etiology
Prerenal Dehydration, perinatal asphyxia, hypotension, and hypokalemia
Renal Acute tubular necrosis, drug nephrotoxicity (aminoglycoside), congeni‐
tal anomalies (hypoplasia, dysplasia, or renal agenesis; polycystic
kidney disease and nephrotic syndrome), vascular abnormalities
(thrombosis of renal artery or vein), infectious causes (pyelonephritis,
congenital syphilis)
Postrenal Neurogenic bladder, posterior urethral valves (PUV), obstructive
megaureter or bilateral or unilateral hydronephrosis in a single kidney
Without associated ARF
High obstructive uropathy Congenital obstructive hydronephrosis, primary obstructive megaure‐
ter, obstruction due to extrinsic compression
Low obstructive uropathy Ectopic ureterocele, neurogenic bladder, urethral obstruction (VUP,
urethral stricture, urethral diverticulum), bladder tumor obstruction
Urinary Sepsis UTI
Diagnosis
- Physical exam: to rule out abdominal masses (distended bladder, hydronephrosis).
- Laboratory: kidney function parameters, CBC, WBC count, urinalysis.
- Imaging tests: kidney and bladder ultrasound to detect hydronephrosis, megaureter,
distended bladder, abdominal masses, etc. to guide further testing.
Treatment: of the underlying disease.
Bladder exstrophy
Congenital malformation (anteriorly open bladder that is fused to the skin). Incidence:
1/10,000‐40,000 births.
associated malformations
Musculoskeletal Abdominal wall dehiscence due to separation of the pubic symphy‐
sis and rectus abdominis and to external rotation of the pubic bones
Anorectal Anus moved forward, sometimes with stenosis
Genital ♂: epispadias, with a wide, short penis with a dorsal cord
♀: bifid clitoris and vaginal stenosis
Diagnosis of suspicion: prenatal ultrasound before 20 weeks. The absence of bladder filling
with normal kidneys and a low‐set umbilical cord with a semisolid protrusion in the ab‐
dominal wall suggests this malformation. Early diagnosis is important because of the possi‐
bility of terminating the pregnancy or, if not, of providing specialized care.
Treatment:
- Erosion of the bladder mucosa must be avoided by ligating the umbilical cord with silk
(the umbilical clamp is removed) and covering the bladder mucosa with wet dressings.
- Surgical: reconstructive surgery in an experienced clinic within the first 48‐72 hours.
Perinatal testicular torsion
Torsion occurs before or around birth. Also known as neonatal or prenatal torsion.
Etiology: non‐adherence of the gubernaculum to the scrotal wall, generating extravaginal
torsion.
Symptoms: newborn with enlarged scrotum that is hard to the touch; loss of skin color.
Diagnostic tests: color Doppler ultrasound of the scrotum.
Treatment: in cases of postnatal torsion, proceed with surgical exploration, performing an
orchiectomy if there is testicular necrosis. Torsion of the contralateral testes may occur
within up to the first 8 weeks when the gubernaculum attaches itself to the scrotal wall.
Neonatal hematuria
Definition: the existence of three or more erythrocytes per field is considered to indicate
microscopic hematuria in newborns.
Macroscopic staining of the urine may also be due to the presence of:
- Bile pigments.
- Porphyria.
- Urate.
It is always pathological.
May have diverse causes:
Causes of neonatal hematuria
Renal vein/artery thrombosis Glomerulonephritis
Obstructive uropathy Cortical necrosis
Polycystic kidney disease Adrenal hemorrhage
Lithiasis DIC
Renal spongiosis Hemorrhagic disease of the newborn
Wilms tumor
Sexual development disorders
The etiology of this disorder should be investigated and treated urgently in order to
avoid serious complications.
Classification: