Abstract: SA-PO0679
Adrenal Insufficiency Due to Adrenal Hemorrhage in a Neonate in the Context of In Utero Buprenorphine Exposure
Session Information
- Pediatric Nephrology: Transplantation, Hypertension, AKI, Genetics, and Developmental Diseases
November 08, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Pediatric Nephrology
- 1900 Pediatric Nephrology
Authors
- Stickles, Eric Benjamin, Lincoln Memorial University - Knoxville Site, Knoxville, Tennessee, United States
- Mims, Bailey Joann, Lincoln Memorial University - Knoxville Site, Knoxville, Tennessee, United States
- Mannemuddhu, Sai Sudha, The University of Tennessee Graduate School of Medicine, Knoxville, Tennessee, United States
Introduction
Neonatal abstinence syndrome (NAS) is a condition in which newborns experience withdrawal symptoms due to in-utero exposure to opioids. We report a case of a neonate with NAS and birth trauma who developed bilateral adrenal hemorrhages and adrenal insufficiency.
Case Description
A 3-day-old full-term female was admitted to the neonatal intensive care unit with hyperbilirubinemia. Birth was complicated by breech presentation and shoulder dystocia. Prenatal course is significant for buprenorphine usage and smoking by the mother. On day of life (DOL) 5, she developed lethargy and feeding difficulties. Laboratory evaluation showed hyponatremia, hyperkalemia, and metabolic acidosis. Imaging revealed bilateral adrenal hemorrhages. WBC count and liver function tests were normal, and CRP was slightly elevated. Cortisol levels were initially low (14 mcg/dL) but increased to 41 mcg/dL on DOL#6. Hydrocortisone, fludrocortisone, and sodium chloride supplementation were started. Serial ultrasound imaging showed improvement in the size of adrenal hematomas. At 2 mons of age, fludrocortisone and sodium chloride were discontinued, and hydrocortisone was gradually weaned over 2 wks, stopping at 2.5 mons of age. Over a 3-month follow-up period, adrenal function and electrolyte levels normalized, and ultrasound confirmed the resolution of adrenal hemorrhages.
Discussion
In a neonate with hyperkalemic acidosis, birth injury, and in utero exposure to buprenorphine, the possibility of adrenal hemorrhage should be considered after ruling out sepsis. Imaging can confirm hemorrhage. In a child with adrenal insufficiency, prompt evaluation and replacement of corticosteroids, mineralocorticoids, and sodium are vital. While buprenorphine is commonly used to treat opioid use disorder during pregnancy, it has been associated with NAS and neonatal complications. This case highlights that the cumulative stress response due to birth trauma and NAS can lead to adrenal hemorrhage in neonates.
Figure 1: Trending biochemical abnormalities.
Figure 2: Ultrasound images of the adrenal and kidneys at DOL#8 and DOL#88