Neonatal Hypercalcemia Secondary to Subcutaneous Fat Necrosis Successfully Treated with Pamidronate: A Case Series and Literature Review

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.

Subcutaneous Fat Necrosis of the Newborn: A Case Report of a Term Infant Presenting with Malaise and Fever at Age of 9 Weeks

“…Corticosteroids and bisphosphonates may be used for further management when adequate reduction in calcium levels is not obtained with the first-line intervention [ 3 ]. Samedi et al [ 19 ], in a case report, noted that the use of pamidronates (a bisphosphonate) had a faster onset of action than corticosteroids and thus advocated it as a possible first-line management of SFN with very severe hypercalcemia. Similarly Alos et al [ 20 ] in a case series involving four infants found that after initial trial of hydration and diuretics and there was not much reduction in iCa levels there was documented good outcome with the use of pamidronates.…”

Management of Multi Organ Dysfunction in Neonatal Encephalopathy

“…Regular full skin observation is suggested in view of the potential complications during TH such as subcutaneous fat necrosis, a benign condition characterized by inflammation and necrosis of subcutaneous fat, and cold panniculitis which is an acute nodular, erythematous eruption. In the TOBY RCT 1% of infants had subcutaneous fat necrosis (204) which can be complicated by hypercalcaemia and require hyperhydration and diuretic treatment (205). Sclerema neonatorum is a diffuse hardening of the subcutaneous tissue during TH that usually self resolves.…”