A 4-day-old male neonate born to a Para-IV mother after 9 months of amenorrhea presented with intermittent reddish discoloration of urine and occasionally passing frank blood per urethra. The mother had antenatal care visits 8 times and there was no problem identified during pregnancy. Delivery was by spontaneous vaginal delivery after a duration of labor of 9 hrs and rupture of membrane of 6 hrs. The delivery was difficult associated with shoulder dystocia. First and fifth minute APGAR scores were 7 and 9 respectively and birth weight was 5000 gm. The neonate did not receive vitamin K after birth. The history was otherwise unremarkable. On physical examination, PR was 112ʹ, RR 42ʹ, temperature 36.7 °C and spO2 96%; weight was 4600 gm and head circumference 35.5 cm. The abdomen was flat, with no palpable mass or organomegaly, and no area of tenderness, bruise, skin discoloration, or sign of fluid collection. Both testicles were palpable in the scrotum and there was no scrotal swelling or discoloration but frank, bright red blood was noticed on the diaper. He had no pallor, skin discoloration,or petechiae and all primitive reflexes were intact. With an initial diagnosis of term, macrosomia, large for gestational age, and hematuria secondary to rule out congenital Wilms’ tumor, he was investigated with CBC (WBC 11,190/µL, hematocrit 69%, and platelets 244,000/µL), urinalysis (blood trace, RBC 3–7/HPF) and renal function test (creatinine 0.84, BUN 20.4). Abdominal ultrasound showed bilateral suprarenal echo complex mass (right 4.3 cm by 2.2 cm and left 4 cm by 2 cm) and abdominal CT scan showed bilateral hypo-dense non-enhancing fluid-attenuated suprarenal gland masses (right 4.3 cm by 2.5 cm and left 3.9 cm by 2.4 cm) with a final conclusion of bilateral suprarenal gland collection likely hemorrhage (). We did not do additional investigations like serum electrolytes (as the patient was clinically stable) and cortisol or ACTH stimulation tests (as these tests were not available in the setting). The neonate was admitted to the neonatal intensive care unit (NICU) for inpatient follow up and we did not provide any treatment apart from follow up as he did not have any additional symptom apart from the hematuria. During the follow up, subsequent hematocrit measurements showed values of 50% and 54% on the 7th and 8th days of life respectively. He stayed in our hospital for 3 days for observation. During his 3-day stay in the NICU, the urinary complaint gradually subsided, his urine became clear, and he was passing urine adequately and doing well clinically. So, he was discharged with parental counseling on the natural course of the disease, the need for subsequent clinical and radiological follow up, and advice on when to return immediately. Follow up evaluation 1 month after discharge showed a well growing infant with no remarkable finding; ultrasound showed bilateral hypo-echoic suprarenal masses decreasing in size (right 2.5 cm by 1.5 cm and left 1.9 cm by 1.8 cm) and all other structures were normal. Follow up ultrasound done at 5 months of age demonstrated normal findings and the infant was doing well with no complaint.