Haematoma complicating subcutaneous fat necrosis of the newborn: a rare complication following therapeutic hypothermia

2020 ◽  
Vol 13 (6) ◽  
pp. e234360
Author(s):  
Elhaytham Omar Sanad Elsayed ◽  
Kamran Yusuf ◽  
Frankie O G Fraulin ◽  
Prashanth Murthy

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.

PEDIATRICS ◽  
2011 ◽  
Vol 128 (2) ◽  
pp. e450-e452 ◽  
Author(s):  
B. Strohm ◽  
A. Hobson ◽  
P. Brocklehurst ◽  
A. D. Edwards ◽  
D. Azzopardi ◽  
...  

2019 ◽  
Vol 38 (4) ◽  
pp. 236-241 ◽  
Author(s):  
Mary Whalen

Subcutaneous fat necrosis (SCFN) is a rare complication, usually occurring in otherwise healthy full-term infants who have experienced some level of trauma that causes ischemic injury to adipose tissue. Tissue injury usually occurs in areas of the body that are exposed to excessive pressure as during delivery. Tissue injury has also been described secondary to therapeutic cooling. This case study presents an infant who received whole body cooling for hypoxic ischemic injury and later developed severe hypercalcemia at one month of age without the skin lesions consistent with SCFN. The differential diagnosis for hypercalcemia and how it relates to SCFN is presented, as well as clinical presentation, treatment, and prognosis.


2014 ◽  
Vol 32 (3) ◽  
pp. 427-429 ◽  
Author(s):  
Linda Tognetti ◽  
Georgios Filippou ◽  
Sara Bertrando ◽  
Valentina Picerno ◽  
Giuseppe Buonocore ◽  
...  

2012 ◽  
Vol 80 (4) ◽  
pp. 355-356
Author(s):  
Nilay Hakan ◽  
Mustafa Aydin ◽  
Ayşegül Zenciroğlu ◽  
Sara Erol ◽  
Nurullah Okumuş

2014 ◽  
Vol 25 (3) ◽  
pp. 184
Author(s):  
Tae Hyeong Kim ◽  
Mi Suk Choi ◽  
Sung-Hoon Chung ◽  
Yong-Sung Choi ◽  
Woo-Young Sim ◽  
...  

2017 ◽  
Vol 21 (5) ◽  
pp. 502-506
Author(s):  
Salwa Khedr ◽  
Anna Piskorski ◽  
Adrienne R Bingham ◽  
Justin Goldstein ◽  
Abbot R Laptook ◽  
...  

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).


2011 ◽  
Vol 2011 (may10 1) ◽  
pp. bcr1220103569-bcr1220103569 ◽  
Author(s):  
K. Alaoui ◽  
S. Abourazzak ◽  
A. Oulmaati ◽  
M. Hida ◽  
A. Bouharrou

Children ◽  
2021 ◽  
Vol 8 (5) ◽  
pp. 374
Author(s):  
Katerina Chrysaidou ◽  
Georgios Sargiotis ◽  
Vasiliki Karava ◽  
Dimitrios Liasis ◽  
Victor Gourvas ◽  
...  

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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