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