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

In the context of this study, neonatal thyroid dysfunction was seen following exposure to iodine via caesarean section but not via exposure to contrast media.

IntroductionHyperglycaemia is common in the very preterm infant and has been associated with adverse outcomes. Preventing hyperglycaemia without increasing the risk of hypoglycaemia has proved challenging. The development of real-time continuous glucose monitors (CGM) to inform treatment decisions provides an opportunity to reduce this risk. This study aims to assess the feasibility of CGM combined with a specifically designed paper guideline to target glucose control in the preterm infant.Methods and analysesThe Real Time Continuous Glucose Monitoring in Neonatal Intensive Care (REACT) trial is an international multicentre randomised controlled trial. 200 preterm infants ≤1200 g and ≤24 hours of age will be randomly allocated to either real-time CGM or standard care (with blinded CGM data collection). The primary outcome is time in target 2.6–10 mmol/L during the study intervention assessed using CGM. Secondary outcomes include efficacy relating to glucose control, utility including staff acceptability, safety outcomes relating to incidence and prevalence of hypoglycaemia and health economic analyses.Ethics and disseminationThe REACT trial has been approved by the National Health Service Health Research Authority National Research Ethics Service Committee East of England (Cambridge Central); Medical Ethics Review Committee, VU University Medical Centre, Amsterdam, The Netherlands and the Research Ethics Committee, Sant Joan de Déu Research Foundation, Barcelona, Spain. Recruitment began in July 2016 and will continue until mid-2018. The trial has been adopted by the National Institute of Health Research Clinical Research Network portfolio (ID: 18826) and is registered with anInternational Standard Randomised Control Number (ISRCTN registry ID: 12793535). Dissemination plans include presentations at scientific conferences, scientific publications and efforts at stakeholder engagement.Trial registration numberISRCTNNCT12793535Pre-results.

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IntroductionThe management of the neonatal patent ductus arteriosus (PDA) remains controversial and subject to much debate. There is uncertainty about the type and timing of medical therapies. There are concerns about the long-term outcome after surgical ligation. Previous studies from our network suggested improved survival.1 Subsequent work highlighted different referrals practices by the tertiary neonatal intensive care units (NICUs). The aim of this service evaluation was to review changing practice across this network over the last 18 years following a more standardised network approach of referral since 2013.MethodsPatients were identified from the Acute Neonatal Transport Service(ANTS) database. All infants requiring PDA ligation were transported by them to cardiac centres for surgical ligation between January 2004 and July 2017.ResultsOver this period 252 neonates have been referred for PDA ligation. The numbers referred annually were a median of 15 (range 5–36), with a peak of 36 referrals in 2011. Most referrals (77%) were from the three tertiary NICUs. Prior to 2011 there was a clear difference in referral rates.ConclusionsA more standardised approach, where usually only infants who had failed extubation were referred for PDA ligation has resulted in a substantial reduction in the number of infants undergoing surgical closure. This reduction is not the result of a changing neonatal population nor a change in specific medical therapies to treat the PDA in any of the units. It almost certainly reflects more tolerance of a PDA alongside careful ventilation, fluid, and nutrition management.Reference. Kang SL, et al. Cardiology in the Young2013;(23):711–716.