Subcutaneous Fat Necrosis in Two Infants After Hypothermic Cardiac Surgery

Glover, Mary; Catterall, M. D.; Atherton, D. J.

doi:10.1111/j.1525-1470.1991.tb00861.x

Cited by 45 publications

(18 citation statements)

References 21 publications

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“…SCFN of the newborn is a transient inflammatory disorder of adipose tissue associated with foetal and neonatal stress [1, 7, 8]. The characteristic lesions consist of firm, painful skin nodules.…”

Section: Discussionmentioning

confidence: 99%

Pamidronate: Treatment for Severe Hypercalcemia in Neonatal Subcutaneous Fat Necrosis

Alos¹,

Eugène²,

Fillion³

et al. 2006

Horm Res Paediatr

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Background: Subcutaneous fat necrosis (SCFN) of the newborn is an uncommon disorder that occurs in the first weeks of life after foetal distress. It can be complicated by potentially life-threatening hypercalcemia. Treatments of hypercalcemia have included hydration, furosemide and corticosteroids. Only one report has described the use of intravenous bisphosphonates for this condition. We propose that pamidronate could be the first line therapy for severe hypercalcemia in SCFN. Patients and Results: Four newborns presented between 2001 and 2004 with SCFN complicated by severe hypercalcemia. At diagnosis, ionized calcium levels were higher than 1.4 mmol/l and were associated with high urinary calcium/creatinine ratios and high 1,25-dihydroxyvitamin D levels. Despite treatment with IV fluids, low calcium diet and furosemide, calcium levels remained high. The patients were given 3–4 doses (0.25–0.50 mg/kg/dose) of pamidronate. Urinary calcium/creatinine ratios and calcium levels decreased within 48–96 h. 1,25-dihydroxyvitamin D levels normalized with resolution of the skin lesions. No persistent nephrocalcinosis was observed. Conclusion: Pamidronate is effective, well-tolerated in the short-term and obviates the need for prolonged treatment with furosemide and corticosteroids. To prevent nephrocalcinosis, pamidronate might be considered as first line treatment for severe hypercalcemia in SCFN.

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Section: Discussionmentioning

confidence: 99%

Pamidronate: Treatment for Severe Hypercalcemia in Neonatal Subcutaneous Fat Necrosis

Alos¹,

Eugène²,

Fillion³

et al. 2006

Horm Res Paediatr

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“…SFN has been described in newborns following hypothermia when abandoned on the street [21] or exposed to cold weather [22]. Moreover, cases of SFN have been observed in newborns treated with applications of ice bags for supraventricular tachycardia [23][24][25][26], or subjected to wholebody cooling before being placed on cardiopulmonary bypass for cardiovascular surgery [27][28][29][30]. Neonates have an increased risk of developing SFN due to the different composition of fatty acid concentrations.…”

Section: Filippi Et Al the Journal Of Maternal-fetal And Neonatalmentioning

confidence: 99%

Strategies for reducing the incidence of skin complications in newborns treated with whole-body hypothermia

Filippi

Catarzi

Padrini

et al. 2012

The Journal of Maternal-Fetal & Neonatal Medicine

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Objective: To present the results of a strategy designed to reduce the incidence of skin complications in newborns with hypoxicischemic encephalopathy treated with moderate whole-body hypothermia. Design: Retrospective study. Setting: Neonatal Intensive Care Unit (NICU). Patients: Thirty-nine neonates cooled in the considered period. Intervention: Starting from January 2008, for neonates treated with moderate whole-body hypothermia (33.5 °C), the cooling system was set in "automatic servo-controlled mode (ACM)", where the temperature of the circulating water could vary between 4 °C and 42 °C. Starting from January 2009, cooling blankets were used in another type of automatic mode, the "gradient variable mode (GVM)", where the circulating water was maintained at a specific pre-set gradient towards the patient's body temperature, and a specific nursing protocol (NP) was adopted. Measurements and main results: Two of the eleven newborns treated with the "ACM" exhibited skin complications compatible with subcutaneous fat necrosis (SFN). None of the twenty-eight newborns treated with the "GVM" exhibited skin complications. A comparison of the biochemical and hematological data between these two groups revealed that newborns treated after the adopting of a NP and the "GVM" showed lower serum protein C and calcium levels, and higher platelet levels. Conclusions: Our data suggest that newborns undergoing therapeutic cooling may benefit from a specific NP and correct cooling unit setting. Should further studies confirm our data, this nursing approach could be easily adopted.

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“…Existen casos de NGS tras aplicar medidas hipotérmicas a neonatos por taquicardia supraventricular y en posoperatorios de cirugía cardíaca. 5,6 Se han sugerido factores genéticos predisponentes relacionados con dislipemia y trombofilia familiar. [7][8][9] Nuestro paciente presentaba varios factores de riesgo para NGS perinatales: hipoxia perinatal, tratamiento con hipotermia, trombocitopenia e hipoglucemia.…”

Section: Discussionunclassified

Necrosis grasa subcutánea con hipercalcemia persistente en un neonato tratado con hipotermia terapéutica. Reporte de un caso

Fernández

Aznar

et al. 2016

Arch Argent Pediat

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Presentación de casos clínicos RESUMENLa hipotermia terapéutica constituye el tratamiento de elección para los recién nacidos con encefalopatía hipóxico-isquémica moderada-grave, que cambia el pronóstico de estos niños y se acepta como una técnica segura y con escasas complicaciones secundarias considerando su beneficio. Un posible efecto adverso es la necrosis grasa subcutánea, una paniculitis transitoria aguda de presentación durante las primeras semanas de vida. Se presenta un caso de un recién nacido a término afecto de encefalopatía hipóxico-isquémica con lesiones cutáneas en forma de eritema multiforme generalizado y placas eritematosas firmes e induradas en la espalda, los glúteos y las extremidades a los 12 días de vida, tras el tratamiento con hipotermia. El estudio histopatológico, tras la biopsia cutánea, confirmó la sospecha de necrosis grasa subcutánea. Al mes de vida, presentó cifras elevadas de calcio sérico, que precisaron tratamiento con hidratación intravenosa y diuréticos. La calcemia descendió hasta normalizarse a los 3 meses, con desaparición progresiva de las lesiones cutáneas. Palabras clave: recién nacido, encefalopatía hipóxico-isquémica, hipotermia inducida, necrosis grasa subcutánea, hipercalcemia. ABSTRACTTherapeutic hypothermia is the current standard treatment in newborns with moderate to severe hypoxic-ischemic encephalopathy, changing the outcome of these children. It is considered a safe technique with almost no side effects. A possible adverse side event is subcutaneous fat necrosis, which is an acute self-limiting panniculitis that develops during the first weeks of life. We report a case of a newborn at term suffering hypoxic-ischemic encephalopathy with a generalized multiform erythematous rash and firm and indurated plaques over the back, buttocks and extremities on his 12 th day of life after being treated with therapeutic hypothermia. Histopathological study after skin punch biopsy confirmed the suspicion of subcutaneous fat necrosis. The infant developed asymptomatic moderate hypercalcaemia within the first month of life, which was Necrosis grasa subcutánea con hipercalcemia persistente en un neonato tratado con hipotermia terapéutica. Reporte de un caso Subcutaneous fat necrosis and persistent hypercalcaemia in a newborn treated with therapeutic neonatal hypothermia. A case report treated with intravenous fluids and diuretics. Serum calcium levels decreased and normalized in 3 months, with progressive disappearance of skin lesions.

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Subcutaneous Fat Necrosis in Two Infants After Hypothermic Cardiac Surgery

Cited by 45 publications

References 21 publications

Pamidronate: Treatment for Severe Hypercalcemia in Neonatal Subcutaneous Fat Necrosis

Pamidronate: Treatment for Severe Hypercalcemia in Neonatal Subcutaneous Fat Necrosis

Strategies for reducing the incidence of skin complications in newborns treated with whole-body hypothermia

Necrosis grasa subcutánea con hipercalcemia persistente en un neonato tratado con hipotermia terapéutica. Reporte de un caso

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