scholarly journals SUN-LB087 Successful Prevention of Common Complications of Severe Hypercalcemia Secondary to Subcutaneous Fat Necrosis of the Newborn Following Whole Body Therapeutic Hypothermia

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Sandra Ilaka-Chibuluzo ◽  
Thomas Conway ◽  
Soumya Nagaraja ◽  
Robert Levine ◽  
Teofilita Issacson
Keyword(s):  
Therapeutic Hypothermia ◽  
Subcutaneous Fat ◽  
Whole Body ◽  
Fat Necrosis ◽  
Subcutaneous Fat Necrosis ◽  
Severe Hypercalcemia ◽  
Successful Prevention

A Case Study of Severe Hypercalcemia Secondary to Subcutaneous Fat Necrosis: A Diagnosis of Exclusion

2019 ◽  
Vol 38 (4) ◽  
pp. 236-241 ◽  
Author(s):  
Mary Whalen
Keyword(s):  
Tissue Injury ◽  
Rare Complication ◽  
Subcutaneous Fat ◽  
Ischemic Injury ◽  
The Body ◽  
Whole Body ◽  
Fat Necrosis ◽  
Subcutaneous Fat Necrosis ◽  
Severe Hypercalcemia

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.

Occult Massive Visceral Fat Necrosis Following Therapeutic Hypothermia for Neonatal Encephalopathy

2017 ◽  
Vol 21 (5) ◽  
pp. 502-506
Author(s):  
Salwa Khedr ◽  
Anna Piskorski ◽  
Adrienne R Bingham ◽  
Justin Goldstein ◽  
Abbot R Laptook ◽  
...  
Keyword(s):  
Therapeutic Hypothermia ◽  
Visceral Fat ◽  
Subcutaneous Fat ◽  
Neurodevelopmental Outcome ◽  
Pulmonary Artery Hypertension ◽  
Whole Body ◽  
Common Side Effect ◽  
Close Monitoring ◽  
Fat Necrosis ◽  
Subcutaneous Fat Necrosis

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).

scholarly journals Subcutaneous Fat Necrosis and Hypercalcemia with Nephrocalcinosis in Infancy: Case Report and Review of the Literature

Children ◽  
2021 ◽  
Vol 8 (5) ◽  
pp. 374
Author(s):  
Katerina Chrysaidou ◽  
Georgios Sargiotis ◽  
Vasiliki Karava ◽  
Dimitrios Liasis ◽  
Victor Gourvas ◽  
...  
Keyword(s):  
Therapeutic Hypothermia ◽  
Late Onset ◽  
Subcutaneous Fat ◽  
Birth Asphyxia ◽  
Fat Necrosis ◽  
Subcutaneous Fat Necrosis ◽  
Severe Hypercalcemia ◽  
Life Threatening ◽  
Term Newborns

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.

Subcutaneous fat necrosis, a rare but serious side effect of hypoxic-ischemic encephalopathy and whole-body hypothermia

2019 ◽  
Vol 47 (9) ◽  
pp. 986-990 ◽  
Author(s):  
Mahdi Alsaleem ◽  
Lina Saadeh ◽  
Valerie Elberson ◽  
Vasantha H.S. Kumar
Keyword(s):  
Therapeutic Hypothermia ◽  
Subcutaneous Fat ◽  
Whole Body ◽  
Subcutaneous Fat Necrosis ◽  
P Values ◽  
Life Threatening ◽  
The Mean ◽  
Body Cooling ◽  
Whole Body Cooling ◽  
Ischemic Encephalopathy

Abstract Objective To describe the clinical characteristics and risk factors in infants with subcutaneous fat necrosis (SFN) following therapeutic hypothermia for hypoxic-ischemic encephalopathy (HIE). Methods A case-control study was performed by a retrospective chart review of infants with moderate or severe HIE admitted to a level IV regional perinatal center and who underwent whole-body cooling. Results A total of 14 (8.1%) of 171 infants with moderate or severe HIE who underwent whole-body cooling developed SFN during hospitalization. There were more females [71% (10/14)] and large-for-gestational age (LGA) infants [28% (4/14)] in the SFN group vs. 36% females (57/157) and 8% LGA infants (13/157) in the group without SFN (P-values of 0.009 and 0.015, respectively). The mean lowest platelet count was lower 108 ± 55 109/L vs. 146 ± 62 109/L and the mean highest calcium level was higher 11.3 ± 2.5 vs. 10.6 ± 0.8 mg/dL in infants with SFN vs. infants without SFN, respectively (P-values of 0.0078 and 0.006, respectively). Distribution of skin lesions followed distinctive patterns representing the areas with direct contact with the cooling blanket. One infant developed severe, life-threatening hypercalcemia that required aggressive management, including diuretics, corticosteroids and bisphosphonates. Conclusion Although SFN is a rare complication of therapeutic hypothermia, it can be a life-threatening condition if complicated by severe hypercalcemia. Infants who undergo therapeutic hypothermia for HIE need regular skin examinations to evaluate for SFN. If SFN is identified, monitoring of serum calcium levels to prevent life-threatening hypercalcemia is recommended.

Subcutaneous Fat Necrosis After Moderate Therapeutic Hypothermia in Neonates

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

scholarly journals Pamidronate as first-line treatment of hypercalcemia in neonatal subcutaneous fat necrosis: A case series

2019 ◽  
Author(s):  
Alexander D Chesover ◽  
Jennifer Harrington ◽  
Farid H Mahmud
Keyword(s):  
Serum Calcium ◽  
Subcutaneous Fat ◽  
Case Series ◽  
Retrospective Chart Review ◽  
Bisphosphonate Therapy ◽  
Fat Necrosis ◽  
First Line ◽  
Retrospective Case ◽  
Subcutaneous Fat Necrosis ◽  
Severe Hypercalcemia

Abstract Background Subcutaneous fat necrosis (SCFN) can be complicated by severe hypercalcemia, which is frequently asymptomatic. Nephrocalcinosis is associated with hypercalcemia and, in other clinical settings, has been linked to furosemide and glucocorticoid use. First-line bisphosphonate therapy treating hypercalcemia in neonatal SCFN is not well described. Objectives To describe the biochemical changes and risk of nephrocalcinosis in infants with hypercalcemia, secondary to neonatal SCFN, treated with initial pamidronate. Methods A retrospective chart review of five infants treated with initial pamidronate and without furosemide or glucocorticoids. Data were collected on the following: timing of presentation, therapeutic response, and presence of nephrocalcinosis. Results Hypercalcemia resolved after 2.8±1.7 days; this is compared to 7.6±2.8 days from previously reported cases utilising alternative therapies (P=0.012). There were no episodes of rebound hypercalcemia or hypocalcemia. Nephrocalcinosis was present in four of five cases. When including published cases, age at diagnosis was associated with presenting serum calcium (P=0.003) and nephrocalcinosis was associated with higher serum calcium (P=0.014) and time from SCFN to hypercalcemia diagnosis (P=0.002). Conclusions This retrospective case series demonstrates that first-line pamidronate treatment was effective and safe in the resolution of hypercalcemia. Nephrocalcinosis was observed, despite the avoidance of furosemide and glucocorticoid therapy, and associated with greater disease severity and duration of hypercalcemia.

Subcutaneous Fat Necrosis in a Newborn after Brief Therapeutic Hypothermia: Ultrasonographic Examination

2014 ◽  
Vol 32 (3) ◽  
pp. 427-429 ◽  
Author(s):  
Linda Tognetti ◽  
Georgios Filippou ◽  
Sara Bertrando ◽  
Valentina Picerno ◽  
Giuseppe Buonocore ◽  
...  
Keyword(s):  
Therapeutic Hypothermia ◽  
Subcutaneous Fat ◽  
Fat Necrosis ◽  
Subcutaneous Fat Necrosis ◽  
Ultrasonographic Examination

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
Keyword(s):  
Therapeutic Hypothermia ◽  
Neonatal Intensive Care ◽  
Rare Complication ◽  
Subcutaneous Fat ◽  
Meconium Aspiration Syndrome ◽  
Large For Gestational Age ◽  
Unusual Complication ◽  
Skin Defect ◽  
Fat Necrosis ◽  
Subcutaneous Fat Necrosis

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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