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Singh P, Murugesan A. Rare cutaneous complication in a neonate undergoing therapeutic hypothermia. Paediatr Child Health 2024; 29:67-68. [PMID: 38586488 PMCID: PMC10996568 DOI: 10.1093/pch/pxad049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 06/16/2023] [Indexed: 04/09/2024] Open
Affiliation(s)
- Praachi Singh
- Department of Neonatology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Ambalakkuthan Murugesan
- Department of Neonatology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
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2
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Elmoghanni Y, Aldhafer A, Khalaf M, Cipe F, Komala G, Saleem T, Yavuz S. Subcutaneous Fat Necrosis of the Newborn After Whole-Body Cooling for Birth Asphyxia. Cureus 2023; 15:e34521. [PMID: 36879717 PMCID: PMC9984657 DOI: 10.7759/cureus.34521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2023] [Indexed: 02/05/2023] Open
Abstract
Therapeutic hypothermia (TH) is a challenging treatment for a neonate who suffers from hypoxic-ischemic encephalopathy. It has been shown to improve neurodevelopmental outcomes and survival in infants with moderate-to-severe hypoxic-ischemic encephalopathy. However, it has severe adverse effects such as subcutaneous fat necrosis (SCFN). SCFN is a rare disorder that affects term neonates. It is a self-limited disorder but can have severe complications such as hypercalcemia, hypoglycemia, metastatic calcifications, and thrombocytopenia. In this case report, we present a term newborn who developed SCFN after whole-body cooling.
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Affiliation(s)
- Yamen Elmoghanni
- Pediatrics, Al Qassimi Women's and Children's Hospital, Sharjah, ARE
| | - Asma Aldhafer
- Pediatrics, Al Qassimi Women's and Children's Hospital, Sharjah, ARE
| | - Mona Khalaf
- Pediatrics, Al Qassimi Women's and Children's Hospital, Sharjah, ARE
| | - Funda Cipe
- Pediatrics, Al Qassimi Women's and Children's Hospital, Sharjah, ARE
| | | | - Tausif Saleem
- Histopathology, Sheikh Khalifa Medical City, Abu Dhabi, ARE
| | - Sinan Yavuz
- Pediatrics, Al Qassimi Women's and Children's Hospital, Sharjah, ARE
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3
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Ferreira S, Machado S, Selores M. Newborn with purplish skin induration of the back. J Paediatr Child Health 2022. [PMID: 36468524 DOI: 10.1111/jpc.14759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 12/12/2019] [Indexed: 12/10/2022]
Affiliation(s)
- Sandra Ferreira
- Department of Dermatology, Centro Hospitalar e Universitário do Porto, Porto, Portugal
| | - Susana Machado
- Department of Dermatology, Centro Hospitalar e Universitário do Porto, Porto, Portugal
| | - Manuela Selores
- Department of Dermatology, Centro Hospitalar e Universitário do Porto, Porto, Portugal
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4
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Frank L, Brandt S, Wabitsch M. Subcutaneous fat necrosis in newborns: a systematic literature review of case reports and model of pathophysiology. Mol Cell Pediatr 2022; 9:18. [PMID: 36427118 PMCID: PMC9700527 DOI: 10.1186/s40348-022-00151-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 11/09/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Subcutaneous fat necrosis of the newborn (SCFN) is a rare disease occurring in the first days of life. Characteristically, the infants show hard nodules in subcutaneous tissue, purple or erythematous in color and appear on the upper back, cheeks, buttocks and limbs. In most cases, SCFN is a self-limiting disease, as the nodules disappear in up to 6 months. A severe complication associated with SCFN is hypercalcaemia. Pathophysiological mechanisms causing SCFN or associated hypercalcaemia are not fully understood yet. METHODS A systematic literature research including the six biggest databases for medical research has been used to identify all published case reports of SCFN. N = 206 publications has been identified containing n = 320 case reports. All cases have been classified into four subgroups (depending on reported serum-calcium-level): hypercalcaemia, normocalcaemia, hypocalcaemia or no information given. Reported maternal factors, birth characteristics, details about SCFN, diagnostics, therapy and long-term observations have been extracted from publications. RESULTS This is the first systematic literature research that summed up all published cases of SCFN from 1948 up to 2018. Information about serum calcium level was given in 64.3% of the cases. From those, the majority showed hypercalcaemia (70.5%) (normocalcaemia 25.1%, hypocalcemia 4.3%). 89.3% of newborns with hypercalcaemia showed suppressed levels of the parathormone. Maternal gestational diabetes, maternal hypertensive diseases during pregnancy, macrosomia (> 4000g), asphyxia and therapeutic hypothermia are risk factors for SCFN. Histological findings showed a granulomatous inflammation in 98% of cases. CONCLUSION We identified that maternal, birth characteristics and therapeutic measures are probably risk factors for SCFN. These risk factors should be taken into account within the care of neonates.
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Affiliation(s)
- Leonie Frank
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics and Adolescent Medicine, University Medical Center Ulm, Ulm, Germany
- Department of Orthopaedics and Trauma Surgery, Oberschwaben Clinic Wangen im Allgäu, Wangen im Allgäu, Germany
| | - Stephanie Brandt
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics and Adolescent Medicine, University Medical Center Ulm, Ulm, Germany
| | - Martin Wabitsch
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics and Adolescent Medicine, University Medical Center Ulm, Ulm, Germany.
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5
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Walden AR, Rowell A, Chowdhary V, Crawford B, Shukla A. Preterm Infant with Persistent Hypercalcemia in the Absence of Cutaneous Nodules. Neoreviews 2022; 23:774-777. [PMID: 36316255 DOI: 10.1542/neo.23-10-e774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
- Alyssa R Walden
- University of Arkansas for Medical Sciences, Little Rock, AR
- Arkansas Children's Hospital, Little Rock, AR
| | - Amy Rowell
- University of Arkansas for Medical Sciences, Little Rock, AR
- Arkansas Children's Hospital, Little Rock, AR
| | - Vikas Chowdhary
- University of Arkansas for Medical Sciences, Little Rock, AR
- Arkansas Children's Hospital, Little Rock, AR
| | - Brendan Crawford
- University of Arkansas for Medical Sciences, Little Rock, AR
- Arkansas Children's Hospital, Little Rock, AR
| | - Ankita Shukla
- University of Arkansas for Medical Sciences, Little Rock, AR
- Arkansas Children's Hospital, Little Rock, AR
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İnce Becerir T, Altincik A, Özhan B, Yüksel S. Severe hypercalcaemia and acute renal failure in an infant with subcutaneous fat necrosis. Paediatr Int Child Health 2021; 41:221-225. [PMID: 33715600 DOI: 10.1080/20469047.2021.1883960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Subcutaneous fat necrosis (SFN) in the newborn is a form of panniculitis which presents with erythematous nodules and indurated plaques. Severe life-threatening hypercalcaemia can occur as a late complication. A 2-month-old girl presented with severe hypercalcaemia and acute renal injury as a complication of SFN. She was admitted to hospital with the chief complaint of failure to thrive. She had a history of therapeutic hypothermia. After successful treatment of the hypercalcaemia with bisphosphonates, the acute renal injury recovered spontaneously. In neonates with SFN, acute renal injury is a rare complication of hypercalcaemia. Timely prevention of the complications of hypercalcaemia in SFN is essential.
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Affiliation(s)
- Tülay İnce Becerir
- Divisions of Nephrology and Endocrinology, Department of Paediatrics, Pamukkale University Faculty of Medicine, Denizli, Turkey
| | - Ayça Altincik
- Divisions of Nephrology and Endocrinology, Department of Paediatrics, Pamukkale University Faculty of Medicine, Denizli, Turkey
| | - Bayram Özhan
- Divisions of Nephrology and Endocrinology, Department of Paediatrics, Pamukkale University Faculty of Medicine, Denizli, Turkey
| | - Selçuk Yüksel
- Divisions of Nephrology and Endocrinology, Department of Paediatrics, Pamukkale University Faculty of Medicine, Denizli, Turkey
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7
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Russomanno K, Yasmine Kirkorian A, Cardis M. Subcutaneous nodules in an infant. Pediatr Dermatol 2021; 38:932-934. [PMID: 34448226 DOI: 10.1111/pde.14562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Kristen Russomanno
- Department of Dermatology, Medstar Georgetown University Hospital/Medstar Washington Hospital Center, Washington, DC, USA.,Department of Internal Medicine, Medstar Washington Hospital Center, Washington, DC, USA
| | - Anna Yasmine Kirkorian
- Division of Dermatology, Children's National Hospital, Washington, DC, USA.,George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Michael Cardis
- Department of Dermatology, Medstar Georgetown University Hospital/Medstar Washington Hospital Center, Washington, DC, USA
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8
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Schofield R, McMaster D, Cotterill A, Musthaffa Y. Lessons learnt in the management of hypercalcaemia secondary to subcutaneous fat necrosis of the newborn. J Paediatr Child Health 2021; 57:947-949. [PMID: 32780907 DOI: 10.1111/jpc.15093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 06/05/2020] [Accepted: 07/06/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Rebekah Schofield
- Department of Endocrinology and Diabetes, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - David McMaster
- Department of Paediatrics, The Tweed Hospital, Tweed Heads, New South Wales, Australia.,Department of Paediatrics, John Flynn Private Hospital, Gold Coast, Queensland, Australia
| | - Andrew Cotterill
- Department of Endocrinology and Diabetes, Queensland Children's Hospital, Brisbane, Queensland, Australia.,School of Clinical Medicine, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Yassmin Musthaffa
- Department of Endocrinology and Diabetes, Queensland Children's Hospital, Brisbane, Queensland, Australia.,School of Clinical Medicine, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Department of Paediatrics, Logan Hospital, Brisbane, Queensland, Australia
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9
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Chrysaidou K, Sargiotis G, Karava V, Liasis D, Gourvas V, Moutsanas V, Christoforidis A, Stabouli S. Subcutaneous Fat Necrosis and Hypercalcemia with Nephrocalcinosis in Infancy: Case Report and Review of the Literature. CHILDREN (BASEL, SWITZERLAND) 2021; 8:children8050374. [PMID: 34065153 PMCID: PMC8151818 DOI: 10.3390/children8050374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 05/04/2021] [Accepted: 05/06/2021] [Indexed: 11/18/2022]
Abstract
Subcutaneous fat necrosis is an uncommon benign panniculitis affecting more commonly full-term newborns. It has been associated with birth asphyxia and meconium aspiration, as well as therapeutic hypothermia. Although the prognosis is generally favorable, complications such as hypercalcemia, thrombocytopenia, hypoglycemia and hypertriglyceridemia may complicate its course. The most serious complication is hypercalcemia that may reach life threatening levels and can be associated with nephrocalcinosis. We thereby describe a case of subcutaneous fat necrosis after therapeutic hypothermia, which presented with late-onset refractory severe hypercalcemia and persistent nephrocalcinosis during the follow up of the patient. Due to the risk of the development of chronic kidney disease, we highlight the importance of careful monitoring of hypercalcemia and review the literature of subcutaneous fat necrosis related to nephrocalcinosis.
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Affiliation(s)
- Katerina Chrysaidou
- 1st Department of Pediatrics, Aristotle University of Thessaloniki, Hippokratio General Hospital Thessaloniki, 54642 Thessaloniki, Greece; (K.C.); (G.S.); (V.K.); (A.C.)
- Department of Pediatrics, St Luke’s Hospital, Panorama, 55236 Thessaloniki, Greece; (D.L.); (V.G.)
| | - Georgios Sargiotis
- 1st Department of Pediatrics, Aristotle University of Thessaloniki, Hippokratio General Hospital Thessaloniki, 54642 Thessaloniki, Greece; (K.C.); (G.S.); (V.K.); (A.C.)
| | - Vasiliki Karava
- 1st Department of Pediatrics, Aristotle University of Thessaloniki, Hippokratio General Hospital Thessaloniki, 54642 Thessaloniki, Greece; (K.C.); (G.S.); (V.K.); (A.C.)
| | - Dimitrios Liasis
- Department of Pediatrics, St Luke’s Hospital, Panorama, 55236 Thessaloniki, Greece; (D.L.); (V.G.)
| | - Victor Gourvas
- Department of Pediatrics, St Luke’s Hospital, Panorama, 55236 Thessaloniki, Greece; (D.L.); (V.G.)
| | | | - Athanasios Christoforidis
- 1st Department of Pediatrics, Aristotle University of Thessaloniki, Hippokratio General Hospital Thessaloniki, 54642 Thessaloniki, Greece; (K.C.); (G.S.); (V.K.); (A.C.)
| | - Stella Stabouli
- 1st Department of Pediatrics, Aristotle University of Thessaloniki, Hippokratio General Hospital Thessaloniki, 54642 Thessaloniki, Greece; (K.C.); (G.S.); (V.K.); (A.C.)
- Correspondence:
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10
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Newborn with purplish skin induration of the back. J Paediatr Child Health 2020; 56:1319-1320. [PMID: 32830888 DOI: 10.1111/jpc.2_14759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 12/12/2019] [Indexed: 11/30/2022]
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11
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Elsayed EOS, Yusuf K, Fraulin FOG, Murthy P. Haematoma complicating subcutaneous fat necrosis of the newborn: a rare complication following therapeutic hypothermia. BMJ Case Rep 2020; 13:13/6/e234360. [PMID: 32532911 DOI: 10.1136/bcr-2020-234360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A term, large for gestational age male newborn, was admitted to the neonatal intensive care unit with meconium aspiration syndrome and severe hypoxic-ischaemic encephalopathy. The baby was treated with therapeutic hypothermia using a total body cooling blanket. After 48 hours, the baby developed tender, indurated subcutaneous nodules consistent with subcutaneous fat necrosis (SCFN). The lesions started initially over the back but gradually spread to cover both shoulders, upper arms, chest area and both thighs. On day 19 of life, multiple small nodules on the back softened and coalesced to form one sizeable fluctuant swelling over the thoracolumbar area. Over a few hours, the swelling rapidly progressed to a large, tense mass with sloughing of the gangrenous overlying skin. This unusual complication of SCFN required surgical intervention for evacuation and debridement of the haematoma followed by graft repair of the skin defect.
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Affiliation(s)
| | - Kamran Yusuf
- Pediatrics-Neonatology, University of Calgary, Calgary, Alberta, Canada
| | - Frankie O G Fraulin
- Section of Pediatric Surgery, Department of Surgery, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Prashanth Murthy
- Pediatrics-Neonatology, University of Calgary, Calgary, Alberta, Canada
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12
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Mendiratta V, Yadav A, Makhija M. Subcutaneous Fat Necrosis of the Newborn. Indian Dermatol Online J 2020; 11:471-472. [PMID: 32695723 PMCID: PMC7367572 DOI: 10.4103/idoj.idoj_318_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 11/06/2019] [Accepted: 11/18/2019] [Indexed: 11/15/2022] Open
Affiliation(s)
- Vibhu Mendiratta
- Department of Dermatology and STD, Lady Hardinge Medical College and Associated Hospital, New Delhi, India
| | - Anuja Yadav
- Department of Dermatology and STD, Lady Hardinge Medical College and Associated Hospital, New Delhi, India
| | - Mani Makhija
- Department of Pathology, Lal Pathology Laboratory, New Delhi, India
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13
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Severe Thrombocytosis in a Newborn with Subcutaneous Fat Necrosis and Maternal Chorioamnionitis. Case Rep Hematol 2020; 2020:5742394. [PMID: 32148979 PMCID: PMC7056997 DOI: 10.1155/2020/5742394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Accepted: 02/05/2020] [Indexed: 11/17/2022] Open
Abstract
Background Subcutaneous fat necrosis (SFN) is a form of transient panniculitis that presents commonly in infants with a history of perinatal insult, particularly hypothermia. It is characterized by subcutaneous nodules and plaques that appear over bony prominences on cheeks, shoulders, buttock, and thighs. SFN is usually associated with various complications including hypercalcemia, thrombocytopenia, hypertriglyceridemia, and hyperglycemia. Case Presentation. We present a unique case of a female infant with a history of maternal chorioamnionitis who presented with SFN at 11 days of life with thrombocytosis. The platelet count decreased during the hospital stay, and thrombocytosis resolved over the course of the next two weeks. She did not have any other hematological or metabolic abnormalities associated with SFN. Conclusion Infants with perinatal stress are at increased risk of developing SFN during the first month of life. Infants with a diagnosis of SFN should be monitored closely for various hematological and metabolic abnormalities that can have serious consequences.
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14
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Kannenberg SMH, Jordaan HF, Visser WI, Ahmed F, Bezuidenhout AF. Report of 2 Novel Presentations of Subcutaneous Fat Necrosis of the Newborn. Dermatopathology (Basel) 2019; 6:147-152. [PMID: 31700855 PMCID: PMC6827445 DOI: 10.1159/000497176] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 01/22/2019] [Indexed: 11/19/2022] Open
Abstract
Subcutaneous fat necrosis of the newborn (SCFNN) is a rare form of panniculitis classically affecting healthy full-term infants. There are a number of predisposing factors including perinatal asphyxia. The condition generally has a benign course with spontaneous resolution, but monitoring for metabolic complications, in particular the potentially life-threatening complication of hypercalcaemia, is critical. The authors report 2 cases of preterm infants with perinatal asphyxia with atypical presentations of SCFNN: the first with bony involvement resembling Langerhans cell histiocytosis and with follicular pseudocarcinomatous hyperplasia on histology; and the second presenting with a huge haematoma requiring surgical debridement. Both cases were initially erroneously diagnosed as pyogenic infections.
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Affiliation(s)
- Susanna M H Kannenberg
- Division of Dermatology, Department of Medicine, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa
| | - H Francois Jordaan
- Division of Dermatology, Department of Medicine, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa
| | - Willem I Visser
- Division of Dermatology, Department of Medicine, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa
| | - Fatima Ahmed
- Dermatology Department, Tawam Hospital, Al Ain City, United Arab Emirates
| | - A Fourie Bezuidenhout
- Department of Radiology, Beth Israel Deaconess Medical Centre, Harvard Medical School, Boston, Massachusetts, USA
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15
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Chan D, Salas-Walinsundin WM, Yap FKP, Koh MJA. Calcium management challenges in a macrosomic child with subcutaneous fat necrosis. BMJ Case Rep 2019; 12:12/2/e227141. [PMID: 30787024 DOI: 10.1136/bcr-2018-227141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We present a case that illustrates the fluctuations in calcium levels to be expected while managing an infant with maternal gestational diabetes mellitus who also develops subcutaneous fat necrosis (SCFN). There is initial hypocalcaemia due to functional hypoparathyroidism, requiring judicious calcium replacement. But with increased extrarenal production of 1,25-dihydroxyvitamin D due to granulomatous inflammation of subcutaneous adipose tissue, hypercalcaemia ensues. With a self-limiting course, SCFN of the newborn has an excellent prognosis and resolves spontaneously. However, aberrations in serum calcium levels can manifest in life-threatening complications and must hence be closely monitored.
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Affiliation(s)
- Daniel Chan
- Paediatric Medicine, KK Women's and Children's Hospital, Singapore
| | | | | | - Mark Jean Aan Koh
- Paediatric Dermatology, KK Women's and Children's Hospital, Singapore
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16
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Stefanko NS, Drolet BA. Subcutaneous fat necrosis of the newborn and associated hypercalcemia: A systematic review of the literature. Pediatr Dermatol 2019; 36:24-30. [PMID: 30187956 DOI: 10.1111/pde.13640] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Subcutaneous fat necrosis of the newborn is an uncommon disorder, and although usually benign, associated hypercalcemia can lead to complications such as failure to thrive and renal failure. Many sources suggest screening for hypercalcemia for 6 months following resolution of skin lesions, but little data are available to support this recommendation. This study examines existing published literature to better guide practitioners regarding screening evaluations of asymptomatic patients with subcutaneous fat necrosis. A systematic review of the literature was conducted using a PubMed English literature search. Data from case reports and case series were collected regarding the presence of hypercalcemia and associated complications, birth history, and age of onset/resolution of skin lesions and laboratory abnormalities. Approximately half (51%) of infants reported had hypercalcemia. Most (77%) developed detectable hypercalcemia within 30 days of skin lesion onset, and 95% developed detectable hypercalcemia within 60 days of skin lesion onset. Hypercalcemia was detected in only 4% of patients > 70 days following onset of skin lesions. Seventy-six percent had resolution of hypercalcemia within 4 weeks of detection. Hypercalcemia was more prevalent in full-term vs pre-term infants (P-value = 0.054), and higher birthweight was significantly associated with an increased risk of developing hypercalcemia (P-value = 0.022). Although gestational age trended toward significance, the only statistically significant clinical feature predicting the development of hypercalcemia was higher birthweight. Current recommendations for laboratory monitoring are not evidence-based, and this study provides interim data to guide practitioners until prospective, randomized controlled trials are conducted.
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Affiliation(s)
- Nicole S Stefanko
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Beth A Drolet
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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17
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Khedr S, Piskorski A, Bingham AR, Goldstein J, Laptook AR, De Paepe ME. Occult Massive Visceral Fat Necrosis Following Therapeutic Hypothermia for Neonatal Encephalopathy. Pediatr Dev Pathol 2018; 21:502-506. [PMID: 29108501 DOI: 10.1177/1093526617737881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Therapeutic hypothermia (head or whole-body cooling) improves survival and neurodevelopmental outcome in term newborns with moderate-to-severe encephalopathy. Hypothermia treatment is well tolerated; the most common side effect is thrombocytopenia. In about 1% of infants, focal subcutaneous fat necrosis has been reported. We describe a case of clinically unsuspected massive visceral fat necrosis in a term infant with Apgar score 0 at 1 min ("resuscitated apparently stillborn" infant) who was treated with therapeutic hypothermia for 72 h and expired on the 25th day of life following a neonatal course complicated by severe encephalopathy, pulmonary artery hypertension, persistent thrombocytopenia, hypoglycemia, and severe basal ganglia-thalamic abnormalities on magnetic resonance imaging. Postmortem examination revealed extensive visceral (brown) fat necrosis, involving thoracic, abdominal, and retroperitoneal adipose tissue, with distinctive sparing of the subcutaneous (white) fat. The fulminant-yet clinically occult-visceral fat necrosis seen in this case suggests that (lesser degrees of) fat necrosis may go unrecognized in hypoxic-ischemic newborns, especially in those treated with hypothermia, and underscores the importance of close monitoring of encephalopathic newborns both in the short and long terms for complications of fat necrosis (hypercalcemia and nephrocalcinosis).
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Affiliation(s)
- Salwa Khedr
- 1 Department of Pathology, Women and Infants Hospital, Providence, Rhode Island.,2 Department of Pathology and Laboratory Medicine, Alpert Medical School, Brown University, Providence, Rhode Island
| | - Anna Piskorski
- 1 Department of Pathology, Women and Infants Hospital, Providence, Rhode Island.,2 Department of Pathology and Laboratory Medicine, Alpert Medical School, Brown University, Providence, Rhode Island
| | - Adrienne R Bingham
- 3 Department of Pediatrics, Women and Infants Hospital, Providence, Rhode Island.,4 Department of Pediatrics, Alpert Medical School, Brown University, Providence, Rhode Island
| | - Justin Goldstein
- 3 Department of Pediatrics, Women and Infants Hospital, Providence, Rhode Island.,4 Department of Pediatrics, Alpert Medical School, Brown University, Providence, Rhode Island
| | - Abbot R Laptook
- 3 Department of Pediatrics, Women and Infants Hospital, Providence, Rhode Island.,4 Department of Pediatrics, Alpert Medical School, Brown University, Providence, Rhode Island
| | - Monique E De Paepe
- 1 Department of Pathology, Women and Infants Hospital, Providence, Rhode Island.,2 Department of Pathology and Laboratory Medicine, Alpert Medical School, Brown University, Providence, Rhode Island
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18
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Golden ET, Dickson P, Simoneaux S. Brown fat necrosis with calcifications in the newborn: Risk factors, radiographic findings, and clinical course. Indian J Radiol Imaging 2018; 28:107-110. [PMID: 29692537 PMCID: PMC5894305 DOI: 10.4103/ijri.ijri_67_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Objective: To describe the radiographic appearance of subclinical calcified brown fat necrosis and the associated clinical and laboratory findings. Materials and Methods: Picture Archiving and Communications Sytem (PACS) was searched using keywords “soft tissue calcification” and “chest.” The clinical record was searched for prior cardiac surgery, bypass, Extracorporeal Membrane Oxygentation (ECMO) and prostaglandin use. Age when calcifications were first detected, location, resolution, and associated laboratory abnormalities were recorded. Results: Nine patients were identified. None had skin lesions. All patients had congenital heart disease and had experienced cardiac/respiratory arrest and/or severe hypotension 1–6 weeks before soft tissue calcifications occurred. Calcifications resolved by 9 weeks to 5 months in 3 patients. The remaining were either deceased or lacked follow-up imaging. Renal ultrasound was performed in all but 1 patient. Nephrocalcinosis was only seen in 1 patient. Conclusion: Brown fat necrosis is subclinical, diagnosed on plain film, and likely self-limited. It occurs in term and preterm infants who have undergone significant systemic stress and carries a poor prognosis.
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Affiliation(s)
- Eleza T Golden
- Department of Radiology and Imaging Sciences, Children's Healthcare of Atlanta and Emory University, 1405 Clifton Road NE, Atlanta, Georgia 30322
| | - Paula Dickson
- Department of Radiology and Imaging Sciences, Children's Healthcare of Atlanta and Emory University, 1405 Clifton Road NE, Atlanta, Georgia 30322
| | - Stephen Simoneaux
- Department of Radiology and Imaging Sciences, Children's Healthcare of Atlanta and Emory University, 1405 Clifton Road NE, Atlanta, Georgia 30322
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19
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Onyiriuka AN, Utomi TE. Hypocalcemia Associated with Subcutaneous Fat Necrosis of the Newborn: Case Report and Literature Review. Oman Med J 2017; 32:518-521. [PMID: 29218131 PMCID: PMC5702996 DOI: 10.5001/omj.2017.99] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 10/21/2016] [Indexed: 11/03/2022] Open
Abstract
Subcutaneous fat necrosis of the newborn (SCFNN) is a rare benign inflammatory disorder of the adipose tissue but may be complicated by hypercalcemia or less frequently, hypocalcemia, resulting in morbidity and mortality. Here we report the case of a neonate with subcutaneous fat necrosis who surprisingly developed hypocalcemia instead of hypercalcemia. A full-term female neonate was delivered by emergency cesarean section for fetal distress and was subsequently admitted to the Special Care Baby Unit. The mother's pregnancy was uncomplicated up to delivery. Her anthropometric measurements were birth weight 4.1 kg (95th percentile), length 50 cm (50th percentile), and head circumference 34.5 cm (50th percentile). The Apgar scores were 2, 3, and 8 at 1, 5, 10 minutes, respectively. There was no abnormal facies and she was fed with breast milk only. On the seventh day of life, the infant was found to have multiple nodules located in the neck, upper back, and right arm. The nodules were firm, well circumscribed with no evidence of tenderness. Her total serum calcium level was 1.55 mmol/L (normal range 2.2 to 2.7 mmol/L) and this was associated with hypotonia and poor sucking reflex. The packed cell volume was 40%. The serum albumin and blood glucose levels were normal. Her blood culture was sterile. A clinical diagnosis of hypocalcemia associated with SCFNN was made. The infant was treated for hypocalcemia (using calcium gluconate) and was carefully followed-up. The skin lesions resolved completely three months after their eruption. Repeat serum calcium measurements at three, six, and nine months of age were all within normal limits. Although SCFNN is a rare benign clinical condition, it may be complicated by hypocalcemia. Therefore, periodic measurements of the serum calcium levels is warranted in such a patient, beginning from the neonatal period up to the age of six months.
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Affiliation(s)
- Alphonsus N. Onyiriuka
- Endocrine and Metabolic Unit, Department of Child Health, University of Benin Teaching Hospital, Benin City, Nigeria
| | - Theodora E. Utomi
- Special Care Baby Unit, Department of Nursing Services, St Philomena Catholic Hospital, Benin City, Nigeria
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20
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Di Bari JA, Nead JA, Schurman SJ. Zoledronic acid for neonatal subcutaneous fat necrosis. Clin Case Rep 2017; 5:567-569. [PMID: 28469850 PMCID: PMC5412799 DOI: 10.1002/ccr3.855] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 12/08/2016] [Accepted: 01/15/2017] [Indexed: 11/08/2022] Open
Abstract
Subcutaneous fat necrosis (SFN) in infants producing severe hypercalcemia is a life-threatening emergency. Pathophysiology may include enhanced gastrointestinal calcium absorption and bone resorption. We treated an infant with SFN and serum calcium of 15 mg/dL with prednisolone and low-dose zoledronic acid. Serum calcium promptly normalized without rebound hypocalcemia, and redosing of zoledronic acid was not necessary.
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Affiliation(s)
- Jeremy A Di Bari
- Resident, Family MedicineSt. Joseph's Hospital Health Center 301 Prospect Ave Syracuse New York 13203 USA
| | - Jennifer A Nead
- Division of Hospital Medicine Department of Pediatrics 5511 Upstate University Hospital SUNY Upstate Medical University 750 East Adams Street Syracuse New York 13210 USA
| | - Scott J Schurman
- Division of Nephrology Department of Pediatrics 5511 Upstate University Hospital SUNY Upstate Medical University 750 East Adams Street Syracuse New York 13210 USA
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21
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Lara LG, Villa AV, Rivas MMO, Capella MS, Prada F, Enseñat MAG. Subcutaneous Fat Necrosis of the Newborn: Report of Five Cases. Pediatr Neonatol 2017; 58:85-88. [PMID: 28237247 DOI: 10.1016/j.pedneo.2014.06.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Revised: 05/11/2014] [Accepted: 06/16/2014] [Indexed: 10/24/2022] Open
Abstract
Subcutaneous fat necrosis of the newborn (SCFN) is a rare, self-limited disorder of the panniculus which appears in the first few weeks of life. SCFN generally follows an uncomplicated course. However, there are important complications for which the patient must be regularly monitored, including thrombocytopenia, hypoglycemia, hypertriglyceridemia, and most importantly, hypercalcemia. We report five infants with SCFN. All children were born at term. The onset of lesions was between 1 day and 20 days after birth. The back was the most frequent location. Birth hypoxia was the most frequent risk factor. Complications included hypercalcemia, hypoglycemia, and metastatic calcifications (disseminated subcutaneous calcifications, nephrocalcinosis, and myocardial calcifications). This study provides the first case of SCFN in the context of hypoxic encephalopathy and refractory septic shock that required extracorporeal membrane oxygenation (ECMO).
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Affiliation(s)
| | | | | | | | - Fredy Prada
- Cardiology Department, Hospital Sant Joan de Déu, Barcelona, Spain
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22
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Ricardo-Gonzalez RR, Lin JR, Mathes EF, McCalmont TH, Pincus LB. Neutrophil-rich subcutaneous fat necrosis of the newborn: A potential mimic of infection. J Am Acad Dermatol 2016; 75:177-185.e17. [PMID: 27157147 DOI: 10.1016/j.jaad.2016.02.1151] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 01/14/2016] [Accepted: 02/03/2016] [Indexed: 01/19/2023]
Abstract
BACKGROUND The inflammatory infiltrate seen in biopsy specimens obtained from patients with subcutaneous fat necrosis of the newborn (SCFN) has classically been described as consisting mostly of histiocytes. However, we encountered patients with SCFN whose biopsy specimens revealed mostly neutrophils, prompting infection to be an initial consideration. OBJECTIVES We sought to describe cases of SCFN in which neutrophils formed the majority of the infiltrate at our institution and in the literature. METHODS We performed a retrospective analysis of patients with SCFN reported at our institution and a literature review of SCFN. RESULTS Thirteen cases of SCFN were identified at our institution. In 2 of 13 cases, neutrophils composed >75% of the inflammatory infiltrate, and both lesions were 1 day old. From the literature review, neutrophils were mentioned as a component of the infiltrate in 10 of 124 cases, but in none were neutrophils described as forming the majority of the infiltrate. LIMITATIONS This study is limited by its retrospective nature and small sample size. CONCLUSIONS Neutrophils can comprise most of the inflammatory cells in patients with SCFN, especially early in the course of the disease. This variant of SCFN can be easily mistaken for infection.
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Affiliation(s)
| | - James R Lin
- Department of Medicine, Kaiser Permanente Medical Center, Santa Clara, California
| | - Erin F Mathes
- Department of Dermatology, University of California, San Francisco, California
| | - Timothy H McCalmont
- Department of Dermatology, University of California, San Francisco, California; Department of Pathology, University of California, San Francisco, California
| | - Laura B Pincus
- Department of Dermatology, University of California, San Francisco, California; Department of Pathology, University of California, San Francisco, California.
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23
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Tuddenham E, Kumar A, Tarn A. Subcutaneous fat necrosis causing neonatal hypercalcaemia. BMJ Case Rep 2015; 2015:bcr-2014-208460. [PMID: 26177996 DOI: 10.1136/bcr-2014-208460] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Hypercalcaemia in neonates is rare and often asymptomatic, but can have significant morbidity. If severe, it can cause symptoms including irritability, vomiting and seizures. We present the case of a baby girl, born at term after a traumatic delivery, who developed severe hypercalcaemia with nephrocalcinosis. She had several large areas of subcutaneous fat necrosis following delivery, with prolonged low-level elevation of C reactive protein. Subcutaneous fat necrosis of the newborn is a rare and underdiagnosed condition, often accompanied by high plasma calcium. Although self-limiting, it is important to recognise and treat this condition to minimise kidney damage, and to avoid unnecessary investigations or treatment with long courses of antibiotics. The infant recovered well, although a degree of nephrocalcinosis remains.
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Affiliation(s)
- Emma Tuddenham
- Department of Clinical Biochemistry, South-West London Pathology Network, Croydon, UK
| | - Arun Kumar
- Department of Paediatrics, Croydon University Hospital, Croydon, UK
| | - Anne Tarn
- Department of Clinical Biochemistry, South-West London Pathology Network, Croydon, UK
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24
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Grass B, Weibel L, Hagmann C, Brotschi B. Subcutaneous fat necrosis in neonates with hypoxic ischaemic encephalopathy registered in the Swiss National Asphyxia and Cooling Register. BMC Pediatr 2015; 15:73. [PMID: 26156857 PMCID: PMC4496817 DOI: 10.1186/s12887-015-0395-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 06/26/2015] [Indexed: 11/10/2022] Open
Abstract
Background Neonates with hypoxic ischaemic encephalopathy (HIE) are routinely treated with therapeutic hypothermia (TH) for 72 h in order to improve neurological outcome. Subcutaneous fat necrosis (SCFN) is an adverse event occurring in neonates with HIE. Methods We analyzed risk factors for SCFN regarding demographic factors, cooling methods and deviation from target temperature range during hypothermia therapy. Data of all neonates registered in the National Asphyxia and Cooling Register in Switzerland between 2011 and 2013 were analyzed. Results 2.8 % of all cooled neonates with HIE developed SCFN. Perinatal and neonatal characteristics did not differ between neonates with and without SCFN. Applied cooling methods did not correlate with the occurrence of SCFN. In neonates with SCFN 83.3 % of all noted temperatures were within the target temperature range versus 77.5 % in neonates without SCFN. Neonates with SCFN showed 3.6 % of all measured temperatures below target temperature range compared to 12.7 % in neonates without SCFN. Conclusion Subcutaneous fat necrosis in the neonate with HIE undergoing TH is a potential adverse event that seems to occur independently from the whole-body cooling method applied and proportion of temperature measurements outside target temperature range. In this cohort, moderate overcooling associated with moderate hypothermia (33.0–34.0 °C) does not seem to be an independent risk factor for SCFN. There is no correlation between the severity of HIE and incidence of SCFN. Electronic supplementary material The online version of this article (doi:10.1186/s12887-015-0395-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Beate Grass
- Department of Paediatric and Neonatal Intensive Care, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland.
| | - Lisa Weibel
- Department of Paediatric Dermatology, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland. .,Department of Dermatology, University Hospital Zurich, 8091, Zurich, Switzerland.
| | - Cornelia Hagmann
- Clinic ofNeonatology, University Hospital Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland.
| | - Barbara Brotschi
- Department of Paediatric and Neonatal Intensive Care, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland.
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25
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Visceral fat necrosis in a newborn after whole body hypothermia. J Pediatr 2015; 166:1545.e1. [PMID: 25851651 DOI: 10.1016/j.jpeds.2015.02.066] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 02/26/2015] [Indexed: 11/24/2022]
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26
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Samedi VM, Yusuf K, Yee W, Obaid H, Al Awad EH. Neonatal hypercalcemia secondary to subcutaneous fat necrosis successfully treated with pamidronate: a case series and literature review. AJP Rep 2014; 4:e93-6. [PMID: 25452891 PMCID: PMC4239139 DOI: 10.1055/s-0034-1395987] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Accepted: 10/01/2014] [Indexed: 11/08/2022] Open
Abstract
Subcutaneous fat necrosis (SCFN) is a noninfectious panniculitis that occurs in term infants who experience significant distress in the 1st weeks of life, including hypoxic ischemic encephalopathy (HIE). Since the introduction of therapeutic hypothermia for HIE, there have been a few published case reports of SCFN, following this modality of treatment. Although, most cases of SCFN resolve spontaneously, SCFN may be associated with hypercalcemia, which may sometimes reach dangerous levels. Approaches used for the management of this potentially life-threatening condition, include hyperhydration, calciuric diuretics, corticosteroids, and in more resistant cases pamidronate, a bisphosphonate. We report our experience on the use of pamidronate in two cases of severe hypercalcemia associated with SCFN following therapeutic hypothermia for HIE. We believe that with increasing use of therapeutic hypothermia for HIE, clinicians are likely to encounter this condition more frequently.
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Affiliation(s)
- Veronica Mugarab Samedi
- Section of Neonatology, Peter Lougheed Centre, Calgary, Alberta, Canada ; Section of Neonatology, University of Calgary, Calgary, Alberta, Canada
| | - Kamran Yusuf
- Section of Neonatology, University of Calgary, Calgary, Alberta, Canada
| | - Wendy Yee
- Section of Neonatology, University of Calgary, Calgary, Alberta, Canada
| | - Hala Obaid
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Essa Hamdan Al Awad
- Section of Neonatology, Peter Lougheed Centre, Calgary, Alberta, Canada ; Section of Neonatology, University of Calgary, Calgary, Alberta, Canada
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27
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Shumer DE, Thaker V, Taylor GA, Wassner AJ. Severe hypercalcaemia due to subcutaneous fat necrosis: presentation, management and complications. Arch Dis Child Fetal Neonatal Ed 2014; 99:F419-21. [PMID: 24907163 PMCID: PMC4134364 DOI: 10.1136/archdischild-2014-306069] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Subcutaneous fat necrosis (SCFN) is a rare form of panniculitis in infants that generally occurs following birth trauma, meconium aspiration, or therapeutic cooling. Severe hypercalcaemia occurs in a subset of patients, but data on its presentation, management and outcomes are limited. This report details the clinical course and complications of infants treated for severe hypercalcaemia (peak serum calcium ≥3.0 mmol/L) due to SCFN. DESIGN Chart review of all infants with SCFN seen at a single paediatric centre over a 13-year period. PATIENTS Seven infants with SCFN developed severe hypercalcaemia, with median peak serum calcium 4.1 mmol/L (range 3.3-5.1). RESULTS Severe hypercalcaemia occurred before 6 weeks of age, and was asymptomatic in 3/7 patients (43%). Most patients were treated with intravenous hydration, furosemide, glucocorticoids and low-calcium formula, which restored normocalcaemia in a median of 9 days (range 2-42). Fever developed during treatment in 4/7 infants (57%): two patients had bacterial infections and two had no infectious source identified. Nephrocalcinosis was present in 5/6 patients (83%) who were evaluated by renal ultrasound. Nephrocalcinosis failed to resolve in all cases over a median follow-up of 20 months (range 8-48), but no renal dysfunction was observed. Eosinophilia, which has not been reported previously in SCFN, was present in 6/7 patients (86%). CONCLUSIONS In this largest series to date of infants with severe hypercalcaemia due to SCFN, novel findings include the common occurrence of fever and a high incidence of persistent nephrocalcinosis without evidence of adverse renal outcomes.
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Affiliation(s)
- Daniel E. Shumer
- Boston Children’s Hospital, Division of Endocrinology, Boston, Massachusetts, USA
| | - Vidhu Thaker
- Boston Children’s Hospital, Division of Endocrinology, Boston, Massachusetts, USA
| | - George A. Taylor
- Boston Children’s Hospital, Department of Radiology, Boston, Massachusetts, USA
| | - Ari J. Wassner
- Boston Children’s Hospital, Division of Endocrinology, Boston, Massachusetts, USA
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28
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Beuzeboc Gérard M, Aillet S, Bertheuil N, Delliere V, Thienot S, Watier E. Surgical management of subcutaneous fat necrosis of the newborn required due to a lack of improvement: a very rare case. Br J Dermatol 2014; 171:183-5. [PMID: 24359190 DOI: 10.1111/bjd.12798] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2013] [Indexed: 12/01/2022]
Abstract
Subcutaneous fat necrosis of the newborn (ScFN) is an uncommon and transient disease characterized by defined areas of fat necrosis and overlying cutaneous nodule lesions. It usually becomes apparent within the first 6 weeks of life in full-term or post-term infants. It is caused by generalized and/or local tissue hypoperfusion. The skin lesions of ScFN tend generally to improve spontaneously in a few weeks. We present a full-term newborn with birth distress. After therapeutic hypothermia, she presented voluminous and numerous subcutaneous fat necrosis with extensive calcifications. Surgical management was decided at her ninth month because of a total lack of regression. Hypercalcaemia, the most threatening complication, appeared only after this delayed surgery.
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Affiliation(s)
- M Beuzeboc Gérard
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hospital Sud - University of Rennes 1, 16 Boulevard de Bulgarie, Rennes, 35200, France
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29
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Gomes MPDCL, Porro AM, Enokihara MMSDS, Floriano MC. Subcutaneous fat necrosis of the newborn: clinical manifestations in two cases. An Bras Dermatol 2014; 88:154-7. [PMID: 24346906 PMCID: PMC3875964 DOI: 10.1590/abd1806-4841.20132229] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Accepted: 11/27/2012] [Indexed: 11/22/2022] Open
Abstract
Subcutaneous fat necrosis of the newborn is an unusual form of panniculitis, with few
cases described in medical literature. The disease affects newborns at term or
post-term, with normal general health. We describe two cases of newborns affected by
the disease. One of them already had lesions since birth. Also, we discuss the use of
puncture for diagnostic assistance.
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Affiliation(s)
| | | | | | - Marcos César Floriano
- Federal University of São Paulo, Paulista Medical School, department of dermatology, São PauloSP, Brazil
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30
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Díaz Díaz J, Morante Valverde R, Delgado Muñoz MD, Matí Carreras E, Bustos Lozano G. [Complicated subcutaneous fat necrosis after hypothermia treatment for severe hypoxic-ischemic encephalopathy]. An Pediatr (Barc) 2014; 81:e36-7. [PMID: 24582128 DOI: 10.1016/j.anpedi.2013.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Revised: 10/30/2013] [Accepted: 11/08/2013] [Indexed: 11/29/2022] Open
Affiliation(s)
- J Díaz Díaz
- Servicio de Pediatría, Hospital Doce de Octubre, Madrid, España.
| | - R Morante Valverde
- Servicio de Cirugía Pediátrica, Hospital Doce de Octubre, Madrid, España
| | - M D Delgado Muñoz
- Servicio de Cirugía Pediátrica, Hospital Doce de Octubre, Madrid, España
| | - E Matí Carreras
- Servicio de Cirugía Pediátrica, Hospital Doce de Octubre, Madrid, España
| | - G Bustos Lozano
- Sección del Servicio de Neonatología, Hospital Doce de Octubre, Madrid, España
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31
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Rork JF, Huang JT, Gordon LB, Kleinman M, Kieran MW, Liang MG. Initial cutaneous manifestations of Hutchinson-Gilford progeria syndrome. Pediatr Dermatol 2014; 31:196-202. [PMID: 24456199 PMCID: PMC4130100 DOI: 10.1111/pde.12284] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Hutchinson-Gilford progeria syndrome (HGPS) is a rare, uniformly fatal, premature aging disease with distinct dermatologic features. We sought to identify and describe the initial skin and hair findings as potential diagnostic signs of the disease. We performed a chart review of the structured initial intake histories of 39 individuals with HGPS enrolled in clinical trials from 2007 to 2010 at Boston Children's Hospital, limited to cutaneous history from birth to 24 months. Medical photographs were provided through the clinical trials and the Progeria Research Foundation Medical and Research Database at Brown University Center for Gerontology and Healthcare Research. All 39 patients reported skin and hair abnormalities within the first 24 months of life. Pathologies included sclerodermoid change, prominent superficial veins, dyspigmentation, and alopecia. The mean age of presentation for each finding was <12 months. The most frequently reported skin feature was sclerodermoid change, which commonly involved the abdomen and bilateral lower extremities. Prominent superficial vasculature manifested as circumoral cyanosis and pronounced veins on the scalp and body. Hypo- and hyperpigmentation were observed over areas of sclerodermoid change. Scalp alopecia progressed in a distinct pattern, with preservation of the hair over the midscalp and vertex areas for the longest period of time. HGPS has distinct cutaneous manifestations during the first 2 years of life that may be the first signs of disease. Awareness of these findings could expedite diagnosis.
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Affiliation(s)
- Jillian F Rork
- Department of Dermatology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
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32
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Rommani SR, M'farrej MK, Nechi S, Kourda M, Fazaa B, Zermani R. [Subcutaneous lesion of a newborn]. Ann Pathol 2013; 33:360-2. [PMID: 24238253 DOI: 10.1016/j.annpat.2013.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Revised: 09/03/2013] [Accepted: 09/12/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Soumaya Rammeh Rommani
- Service d'anatomie et de cytologie pathologiques, hôpital Charles-Nicolle, Tunis, Tunisie.
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Abstract
Because neuroprotective cooling for hypoxic ischemic encephalopathy (HIE ) becomes more commonplace in NICU s, health care providers should be familiar with the complications of this therapy. Therapeutic cooling improves neurodevelopmental outcomes and has relatively few side effects. One unexpected outcome that has been reported is subcutaneous fat necrosis (SCFN). This column describes the problem, and recommends that NICU staff be vigilant in their observation for, as well as timely in their interventions to help prevent SCFN.
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34
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Abstract
Subcutaneous fat necrosis of infancy is a rare disorder of subcutaneous adipose tissue that is sometimes complicated by hypercalcemia. Complete resolution is common. From the pediatrician's point of view, the disease is a rare but important cause of inconsolable cry in a newborn.
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Affiliation(s)
- Arijit Coondoo
- Department of Dermatology, KPC, Medical College and Hospital, Kolkata, India
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35
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A neonate with subcutaneous fat necrosis after passive cooling: does polycythemia have an effect? Case Rep Pediatr 2013; 2013:254089. [PMID: 23936711 PMCID: PMC3722966 DOI: 10.1155/2013/254089] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Accepted: 06/24/2013] [Indexed: 11/18/2022] Open
Abstract
Subcutaneous fat necrosis (SCFN) is an inflammatory disorder of adipose tissue. The main risk factors for the development of SCFN are perinatal asphyxia and hypothermia. Presented here is a case of a newborn who developed SCFN in association with polycythemia and hypocalcemia following treatment by passive cooling. Neonates who undergo passive or whole body cooling therapy should be closely monitored for any signs of SCFN.
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36
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Tizki S, Lasry F, Elftoiki FZ, Hadj Khalifa H, Itri M, Khadir K, Benchikhi H. [Renal ultrasound in fat necrosis]. Arch Pediatr 2013; 20:768-71. [PMID: 23726682 DOI: 10.1016/j.arcped.2013.04.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Revised: 12/28/2012] [Accepted: 04/16/2013] [Indexed: 11/30/2022]
Abstract
Subcutaneous fat necrosis is an uncommon disease that may be complicated with potentially fatal hypercalcemia or with nephrocalcinosis. We report on the case of a patient with a history of significant perinatal asphyxia, hospitalized for a urinary tract infection. Lesions of subcutaneous fat necrosis were noted, with asymptomatic hypercalcemia at 3.9mmol/L. A renal ultrasound was performed and showed echogenic medullary pyramids bilaterally, consistent with nephrocalcinosis and left nephrolithiasis. The treatment of hypercalcemia included hyperhydration, a diuretic and corticosteroids. Progression was characterized by the total regression of skin lesions and normalization of serum calcium. Hypercalcemia is a rare complication of subcutaneous fat necrosis. It develops within days to weeks after the appearance of skin lesions. Nephrocalcinosis appears after several weeks or months. Hypercalcemia must be treated in due time to avoid the impact on the kidney.
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Affiliation(s)
- S Tizki
- Unité de néphrologie pédiatrique, pédiatrie III, hôpital d'enfants Abderrahim-Harouchi, CHU Ibn Rochd, rue El Faidouzi, Casablanca, Maroc.
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37
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Akcay A, Akar M, Oncel MY, Kızılelma A, Erdeve O, Oguz SS, Uras N, Dılmen U. Hypercalcemia due to subcutaneous fat necrosis in a newborn after total body cooling. Pediatr Dermatol 2013; 30:120-3. [PMID: 22352980 DOI: 10.1111/j.1525-1470.2011.01716.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Subcutaneous fat necrosis is an inflammatory disorder of adipose tissue. Although patients need long-term follow-up to prevent hypercalcemia, the prognosis is generally favorable. We herein present a case of a newborn who developed subcutaneous fat necrosis-related hypercalcemia after hypothermia treatment for hypoxic ischemic encephalopathy. Widespread use of hypothermia treatment for hypoxic ischemic encephalopathy in the neonatal intensive care unit may increase the risk of developing subcutaneous fat necrosis and subsequently hypercalcemia. Great care should be taken to recognize skin findings early in newborns receiving hypothermia treatment, and those diagnosed with subcutaneous fat necrosis require close follow-up because they are at risk for developing hypercalcemia.
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Affiliation(s)
- Ahmet Akcay
- Zekai Tahir Burak Maternity Teaching Hospital, Ankara, Turkey
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Filippi L, Catarzi S, Padrini L, Fiorini P, la Marca G, Guerrini R, Donzelli GP. Strategies for reducing the incidence of skin complications in newborns treated with whole-body hypothermia. J Matern Fetal Neonatal Med 2012; 25:2115-21. [PMID: 22524246 DOI: 10.3109/14767058.2012.683898] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To present the results of a strategy designed to reduce the incidence of skin complications in newborns with hypoxic-ischemic encephalopathy treated with moderate whole-body hypothermia. DESIGN Retrospective study. SETTING Neonatal Intensive Care Unit (NICU). PATIENTS Thirty-nine neonates cooled in the considered period. INTERVENTION Starting from January 2008, for neonates treated with moderate whole-body hypothermia (33.5 °C), the cooling system was set in "automatic servo-controlled mode (ACM)", where the temperature of the circulating water could vary between 4 °C and 42 °C. Starting from January 2009, cooling blankets were used in another type of automatic mode, the "gradient variable mode (GVM)", where the circulating water was maintained at a specific pre-set gradient towards the patient's body temperature, and a specific nursing protocol (NP) was adopted. MEASUREMENTS AND MAIN RESULTS Two of the eleven newborns treated with the "ACM" exhibited skin complications compatible with subcutaneous fat necrosis (SFN). None of the twenty-eight newborns treated with the "GVM" exhibited skin complications. A comparison of the biochemical and hematological data between these two groups revealed that newborns treated after the adopting of a NP and the "GVM" showed lower serum protein C and calcium levels, and higher platelet levels. CONCLUSIONS Our data suggest that newborns undergoing therapeutic cooling may benefit from a specific NP and correct cooling unit setting. Should further studies confirm our data, this nursing approach could be easily adopted.
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Affiliation(s)
- Luca Filippi
- Neonatal Intensive Care Unit, Medical Surgical Feto-Neonatal Department, A. Meyer University Children's Hospital, Florence, Italy.
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Hogeling M, Fardin SR, Frieden IJ, Wargon O. Forehead pressure necrosis in neonates following continuous positive airway pressure. Pediatr Dermatol 2012; 29:45-8. [PMID: 21995718 DOI: 10.1111/j.1525-1470.2011.01537.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
After treatment with continuous positive airway pressure (CPAP) via nasal masks and a face mask, three neonates developed pressure necrosis involving their central forehead and left eyebrow. The pressure necrosis resulted in permanent scarring in all three infants. We describe a case series of a new cutaneous iatrogenic complication of CPAP.
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Affiliation(s)
- Marcia Hogeling
- Department of Pediatric Dermatology, Sydney Children's Hospital, Sydney, New South Wales, Australia.
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Hogeling M, Meddles K, Berk DR, Bruckner AL, Shimotake TK, Cohen RS, Frieden IJ. Extensive subcutaneous fat necrosis of the newborn associated with therapeutic hypothermia. Pediatr Dermatol 2012; 29:59-63. [PMID: 21906137 DOI: 10.1111/j.1525-1470.2011.01374.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Subcutaneous fat necrosis of the newborn is a form of panniculitis that most often occurs in full-term infants with predisposing risk factors. Three neonates with hypoxic ischemic encephalopathy were treated with therapeutic hypothermia and developed extensive subcutaneous fat necrosis. All three infants developed extensive subcutaneous fat necrosis, involving the back, scalp, and arms. Mild, asymptomatic hypercalcemia was noted in one infant in the weeks following the subcutaneous fat necrosis. Hypothermia as a risk factor for subcutaneous fat necrosis is reviewed. Clinicians should be aware of subcutaneous fat necrosis as a possible risk factor and complication associated with asphyxiated newborns who may undergo therapeutic hypothermia. Future studies for therapeutic hypothermia should evaluate neonates for the development of subcutaneous fat necrosis.
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Affiliation(s)
- Marcia Hogeling
- Department of Dermatology, University of California, San Francisco, California, USA.
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Akın MA, Akın L, Sarıcı D, Yılmaz İ, Balkanlı S, Kurtoğlu S. Follow-up during early infancy of newborns diagnosed with subcutaneous fat necrosis. J Clin Res Pediatr Endocrinol 2011; 3:216-8. [PMID: 22155466 PMCID: PMC3245497 DOI: 10.4274/jcrpe.355] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Subcutaneous fat necrosis of the newborn (ScFN) is an uncommon condition caused by generalized and/or local tissue hypoperfusion. The skin lesions of ScFN tend to improve spontaneously. However, ScFN may also lead to complications which cause serious problems. The severity of the etiologic factors contributing to the development of the disease determines the severity of complications. Therefore, these patients should be closely monitored for complications, especially for hypercalcemia which may be life-threatening. The severity and duration of hypercalcemia are associated with the extensity of skin lesions. We present a newborn who developed ScFN as a result of systemic hypotension. The ScFN resolved after the first few weeks of life, but the patient developed mild hypercalcemia during the 4-month follow-up period. The infant was breast-fed during follow-up, and vitamin D prophylaxis was not initiated. The hypercalcemia resolved within four months without any complications. We would like to draw attention to the need to monitor serum calcium levels in these infants and to refrain from initiating vitamin D prophylaxis in the first months of life.
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Affiliation(s)
- Mustafa Ali Akın
- Erciyes University, Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Kayseri, Turkey.
| | - Leyla Akın
- Erciyes University, Faculty of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology, Kayseri, Turkey
| | - Dilek Sarıcı
- Erciyes University, Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Kayseri, Turkey
| | - İbrahim Yılmaz
- Erciyes University, Faculty of Medicine, Department of Pediatrics, Kayseri, Turkey
| | - Süleyman Balkanlı
- Erciyes University, Faculty of Medicine, Department of Pathology, Kayseri, Turkey
| | - Selim Kurtoğlu
- Erciyes University, Faculty of Medicine, Department of Pediatrics, Division of Neonatology and Pediatric Endocrinology, Kayseri, Turkey
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Mitra S, Dove J, Somisetty SK. Subcutaneous fat necrosis in newborn-an unusual case and review of literature. Eur J Pediatr 2011; 170:1107-10. [PMID: 21318229 DOI: 10.1007/s00431-011-1405-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2010] [Accepted: 01/18/2011] [Indexed: 11/29/2022]
Abstract
UNLABELLED Subcutaneous fat necrosis (SCFN) of the newborn is an uncommon, self-limiting panniculitis mostly occurring within the first few weeks after birth. SCFN has been described mostly in term or post-term newborn infants in literature. We report a preterm infant developing extensive subcutaneous fat necrosis within the first week of life after significant perinatal hypoxic injury. The infant was conservatively managed for subcutaneous fat necrosis but developed hypercalcaemia and required prolonged medical treatment. Hypercalcaemia is a rare but serious complication of subcutaneous fat necrosis and needs prolonged follow-up. The etiopathogenesis of both subcutaneous fat necrosis in newborn and the resultant hypercalcaemia are poorly understood. CONCLUSION Significant subcutaneous fat necrosis can develop in both preterm and term infants, and preterm infants also develop significant complications including hypercalcaemia.
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Affiliation(s)
- Subhabrata Mitra
- Clinical Research Fellow in Neonatology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Trust, Cambridge, CB2 0QQ, UK.
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Gold DL. Visual diagnosis: perceived fevers and back pain in a 1-week-old Infant. Pediatr Rev 2011; 32:27-30. [PMID: 21196503 DOI: 10.1542/pir.32-1-27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Delia L Gold
- Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA
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Akin MA, Akin L, Coban D, Akcakus M, Balkanli S, Kurtoglu S. Post-operative subcutaneous fat necrosis in a newborn: a case report. Fetal Pediatr Pathol 2011; 30:363-9. [PMID: 21843053 DOI: 10.3109/15513815.2011.587494] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Subcutaneous fat necrosis of the newborn (ScFN) is an uncommon condition of neonates and infants. The disorder is caused by generalized and local tissue hypoperfusion. The ScFN tends to improve spontaneously with or without some severe complications such as hypercalcemia. The ScFN may occur as iatrogenic after hypothermic surgical interventions. We present iatrogenic ScFN in a newborn with uncomplicated hypercalcemia due to cold exposure on operating table during at an umbilical cord hernia operation. To our knowledge, this is the first report of a patient in whom ScFN occurred during a commonly performed and relatively short-term "nonhypothermic" operation.
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Affiliation(s)
- Mustafa Ali Akin
- Department of Neonatology, Erciyes University School of Medicine, Kayseri, Turkey.
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Gómez-Fernández C, Feito Rodríguez M, Collantes Bellido E, Ybarra Zabala M, de Lucas Laguna R. [Indurated plaque on the back of a newborn after undergoing whole-body cooling]. An Pediatr (Barc) 2010; 74:64-6. [PMID: 21147049 DOI: 10.1016/j.anpedi.2010.09.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2010] [Revised: 09/08/2010] [Accepted: 09/19/2010] [Indexed: 11/18/2022] Open
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Zifman E, Mouler M, Eliakim A, Nemet D, Pomeranz A. Subcutaneous fat necrosis and hypercalcemia following therapeutic hypothermia--a patient report and review of the literature. J Pediatr Endocrinol Metab 2010; 23:1185-8. [PMID: 21284334 DOI: 10.1515/jpem.2010.186] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Subcutaneous fat necrosis (SCFN) of the newborn is an uncommon dermatologic disorder characterized by firm, palpable subcutaneous nodules or plaques with or without erythema. Despite its benign course, SCFN may become complicated by extracutaneous manifestations. Hypercalcemia is considered a rare complication, but it is potentially fatal if unrecognized. During the last several years therapeutic hypothermia (TH) became an essential new therapeutic modality for severe neonatal asphyxia. We report a neonate who presented with SCFN and hypercalcemia following hypothermia therapy for hypoxic ischemic encephalopathy (HIE) and provide a review of the contemporary literature on the topic. We believe that this is important since the use of TH is rapidly increasing, and therefore, the possible side effects including SCFN and hypercalcemia may also become more prevalent. This prompts the need for awareness by treating physicians for this complication.
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Affiliation(s)
- Eyal Zifman
- Pediatric Department, Meir Medical Center, Kfar-Saba, Sackler School of Medicine, Tel-Aviv University, Israel
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Abstract
PURPOSE OF REVIEW In this review, we define hypercalcemia levels, common causes for hypercalcemia in children, and treatment in order to aid the practicing pediatrician. RECENT FINDINGS One rare cause of hypercalcemia in the child is familial hypocalciuric hypercalcemia (also termed familial benign hypercalcemia). Mutations that inactivate the Ca-sensing receptor gene FHH have been described as an autosomal dominant disorder, but recently milder mutations in the CASR have been shown to cause hypercalcemia when homozygous. SUMMARY Normal serum levels of calcium are maintained through the interplay of parathyroid, renal, and skeletal factors. In this review, we have distinguished the neonate and infant from the older child and adolescent because the causes and clinical features of hypercalcemia can differ in these two age groups. However, the initial approach to the medical treatment of severe or symptomatic hypercalcemia is to increase the urinary excretion of calcium in both groups. In most cases, hypercalcemia is due to osteoclastic bone resorption, and agents that inhibit or destroy osteoclasts are, therefore, effective treatments. Parathyroid surgery, the conventional treatment for adults with symptomatic primary hyperparathyroidism, is recommended for all children with primary hyperparathyroidism.
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Kim JH, Jeong SY, Kim IH, Son SW. Subcutaneous fat necrosis of the newborn associated with ventricular septal defect and patent ductus arteriosus. Int J Dermatol 2009; 48:1021-3. [DOI: 10.1111/j.1365-4632.2009.04094.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lund JJ, Xia L, Kerr S, Stratman EJ, Patten SF. The utility of a touch preparation in the diagnosis of fluctuant subcutaneous fat necrosis of the newborn. Pediatr Dermatol 2009; 26:241-3. [PMID: 19419492 DOI: 10.1111/j.1525-1470.2009.00898.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Subcutaneous fat necrosis of the newborn (SFNN) is an uncommon self-limiting panniculitis. Lesions may be fluctuant and spontaneously drain. Here we report a technique to rapidly confirm the diagnosis of SFNN when fluctuance exists via a touch preparation that demonstrates the characteristic histologic features of this condition. The material can be collected by fine needle aspirate, from draining fluctuant lesions, or if biopsy if performed.
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Affiliation(s)
- Jared J Lund
- Department of Dermatology, Marshfield Clinic, Marshfield, Wisconsin 54449, USA
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