Subcutaneous fat necrosis of the newborn: Be aware of hypercalcaemia

Borgia, Francesco; Pasquale, Loredana De; Cacace, Caterina; Meo, Petronilla; Guarneri, Claudio; Cannavò, Serafinella Patrizia

doi:10.1111/j.1440-1754.2006.00862.x

Cited by 36 publications

(32 citation statements)

References 14 publications

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“…Varan et al suggested that severe anaemia in the neonatal period may trigger subcutaneous fat necrosis by reduced tissue perfusion with relative hypoxia and hypothermia [13]. Hypertryglyceridemia has been described in three cases [3,12,14]. It has been documented just before or during the appearance of the cutaneous lesions suggesting a possible mobilisation of fatty acids from affected adipocytes.…”

Section: Discussionmentioning

confidence: 95%

Subcutaneous fat necrosis in newborn—an unusual case and review of literature

2011

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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.Keywords Subcutaneous fat necrosis of newborn . Hypercalcaemia . Perinatal hypoxia . Hypoglycaemia Case reportA male preterm infant weighing 2,300 g was born after a crash Caesarean section at a gestational age of 33+6 weeks. His mother presented with a foetal heart of 30/min and a history of reduced foetal movements for 24 h. The infant was born in poor condition (blue, floppy with no respiratory effort) and no heart rate was noted at birth. The infant needed full cardiopulmonary resuscitation till 4 min of age. First heart rate was detected at 2 min of age, and first gasping effort was noted at 9 min of age, The infant needed continued ventilatory support in view of poor respiratory effort. Apgar scores were 1 at 1 min and 5 at 5 min. Cord blood gases reflected severe combined respiratory and metabolic acidosis. He was ventilated for the first 24 h of life.He suffered from severe hypoxic ischaemic encephalopathy, and abnormal movements of both the upper extremities were noted from 11 h of age. In view of his prematurity, therapeutic hypothermia was not considered appropriate. He was treated with phenobarbitone for the first 6 days of life. He developed abnormal liver and renal functions and also developed severe hypoglycaemia requiring high concentration of dextrose infusion (25% dextrose) to maintain normoglycaemia (total fluid intake was restricted initially in view of severe hypoxic ischaemic encephalopathy (HIE)). Generalised hypertonia was noted very early in life. He developed large bilateral intraventricular haemorrhages which subsequently resulted in bilateral posthaemorrhagic hydrocephalus.He developed an erythematous rash over the dorsum of the chest, abdomen, and right arm which felt warm in comparison to the rest of the body on the third day of life. This developed into a sclerematous appearance by day 5. A punch biopsy of skin confirmed subcutaneous fat necrosis

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Section: Discussionmentioning

confidence: 95%

Subcutaneous fat necrosis in newborn—an unusual case and review of literature

2011

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“…The prognosis of the disease is generally good, but it can be complicated by potentially life‐threatening metabolic alterations. Hypercalcaemia is the most dangerous complication of ScFN, and must be treated adequately and quickly …”

Section: Discussionmentioning

confidence: 99%

“…Hypercalcaemia is the most dangerous complication of ScFN, and must be treated adequately and quickly. 10,12,14,16,18,19 To date, and to the best of our knowledge, no case of surgical management for therapeutic purposes has been reported, with the exception of ulcerated lesions. 13,20 No author has ever addressed the issue of lack of regression of lesions.…”

Section: Discussionmentioning

confidence: 99%

Surgical management of subcutaneous fat necrosis of the newborn required due to a lack of improvement: a very rare case

et al. 2014

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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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“…Furosemide may be helpful to induce calciuresis, but has to be used carefully in order to avoid dehydration and consequent worsening of hypercalcemia. Corticosteroids, calcitonin, citrate and bisphosphonates may be required as second-line therapy in resistant cases (10,15). Hypertriglyceridemia and anemia may also occur, as well as thrombocytopenia and hypoglycemia (8,10,14).…”

Section: Discussionmentioning

confidence: 99%