Subcutaneous Fat Necrosis of the Newborn and Idiopathic Hypercalcemia

Abstract

A newborn with important signs of fetal disturbance and respiratory distress developed plaques on both buttocks 14 days after birth with the clinical and histological characteristics of subcutaneous fat necrosis of the newborn. Fifteen days after the onset of the cutaneous signs, a discrete degree of hypercalcemia was detected. Its outcome was favorable due to the early establishment of a diet rich in medium-chain triglycerides and devoid of calcium and vitamin D. Sixteen cases of idiopathic hypercalcemia in newborn with subcutaneous fat necrosis have been reported of which 3 died. Serial serum calcium determinations should be made in such infants and they should be observed closely for signs and symptoms of hypercalcemia.

Subcutaneous Fat Necrosis, Hypercalcemia, and Prostaglandin E

“…The hypercalcemia will follow in infants with unregulated 1,25(OH)2D3 production. This is compatible with the temporal course of events observed clinically: not all infants with SCFN develop hypercalcemia; fat necrosis usually occurs before the hypercalcemia and rarely lasts more than two weeks; the hypercalcemia usually occurs during the resolution phase of panniculitis and can last up to two months (5,7). This is also compatible with clinical observations of increased cortical bone deposition and hyperostosis in infants receiving long-term PGEj (up to 60 days) while they await cardiac transplantation (22), None of 86 infants in a recent series had abnormal calcium metabolism (J Emery, personal communication, October 25, 1944),…”

“…Although this hypothesis has been invoked to explain the SCFN occurring in neonates and infants undergoing hypothermic cardiac surgery, provocative testing with ice cube application to the skin of predisposed neonates failed to reproduce the SCFN. Some infants with SCFN progress and develop hypercalcemia (1)(2)(3)(4)(5)(6)(7)(8)(10)(11)(12)(13)(17)(18)(19). The hypercalcemic phase usually occurs during resolution of panniculitis but may occur concurrently.…”

“…It may appear over the trunk, arms, buttocks, and cheeks of full-term infants in the first one to two months of life. In some patients associated thrombocytopenia, hypoglycemia (1,2), hypercalcemia (2,3,(4)(5)(6)(7)(8), and hyperlipidemia (9) were reported. The hypercalcemia in particular is associated with a less favorable prognosis (3 deaths in a series of 15 patients) (10).…”

Subcutaneous Fat Necrosis of the Newborn and Hypercalcemia: Case Report and Review of the Literature

“…Hypercalcemia in SCFN (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19) is a relatively rare complication that may result in death secondary to its sequelae (10,13,15). Review of all 20 reported cases ( Table 2) indicates that the typical neonate is approximately 1 week postterm.…”

“…Hypercalcemia occurs one to four months after onset of the skin lesions. Since the association between SCFN and hypercalcemia was made in 1926 (5), only 19 cases have been reported in the literature (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19). Three of the neonates died due to the sequelae of hypercalcemia (10,13,15).…”