Subcutaneous Fat Necrosis Of Newborn Research Articles

P14 Blueberry muffin syndrome secondary to acute myeloid leukaemia: a learning point

Abstract A baby was initially referred at 6 weeks developing multiple erythematous, bruise-like and light-brown subdermal lumps over the head, face, arms, legs and buttocks. She had been born following breech presentation by elective C-section, which had been complicated by trauma and blood loss. No other clinical concerns were raised at this time. Nonaccidental injury was considered; however, subcutaneous fat necrosis of the newborn was the diagnosis made by paediatric team following slightly raised calcium and suggestive ultrasounds features. Newer lesions continued to arise in the same areas over 6 weeks, now with difficulty in feeding and irritability. One small cervical lymph node could be palpated. This was atypical for subcutaneous fat necrosis of the newborn and an urgent dermatological option was sought. On review, the lesions were clinically in keeping with an infiltrative process (blueberry muffin syndrome) and an urgent skin biopsy, blood film and TORCH screen were requested. A 4-mm punch biopsy confirmed leukaemia cutis with evidence of myeloid differentiation. MLL (KMT2A) rearrangement was detected, which was also subsequently found on a bone marrow sample. A peripheral blood film identified a population for NG2-positive myeloid blasts (6%), raising the possibility of infant acute myeloid leukaemia (AML). A TORCH screen did not highlight any congenital infections. The baby was promptly commenced on chemotherapy for AML. This case highlights how presentation can be atypical, the importance of reviewing possible diagnoses and considering an early biopsy to enable prompt treatment if required.

Subcutaneous fat necrosis of the newborn: A retrospective study of 32 infants and care algorithm.

To describe the clinical and laboratory outcomes of infants with subcutaneous fat necrosis of the newborn (SCFN) and propose a care algorithm. This single-center, retrospective study of infants diagnosed with SCFN at Ann & Robert H. Lurie Children's Hospital of Chicago from 2009 to 2019. Of 32 infants who met inclusion criteria, most were born full-term (84%), born via cesarean section (58%), had normal weight for gestational age (69%), and experienced delivery complications (53%). Twenty-nine infants (91%) had calcium drawn, and all had hypercalcemia. Three infants developed clinical symptoms of hypercalcemia, two required hospital admission, two developed nephrocalcinosis, and one developed acute kidney injury. The majority of infants (62%) had a peak ionized calcium between 1.5 and 1.6 mmol/L. No infants with peak ionized calcium less than 1.5 mmol/L developed complications of hypercalcemia. Most patients were diagnosed with hypercalcemia (86%) and demonstrated peak ionized calcium levels (59%) within the first 28 days of life. No patients developed hypercalcemia after 3months of age. Hypercalcemia occurred in 100% of infants who had laboratory monitoring. We recommend obtaining an initial ionized calcium level when SCFN is suspected, and monitoring for the first 3 months of life if hypercalcemia has not been detected. In patients with asymptomatic hypercalcemia less than 1.5 mmol/L, there appears to be low likelihood of related complications. For symptomatic, markedly elevated (>1.6 mmol/L), or persistently elevated levels (>6months) we suggest coordinated care with endocrinology or nephrology, consider hospitalization, and urinary system ultrasound.

SUBCUTANEOUS FAT NECROSIS OF THE NEWBORN: CLINICAL CASE

A rare case of SCFN was diagnosed in a newborn, a rare disease in the neonatal period, emphasizes the importance of a histological findings for a definitive diagnosis. Subcutaneous fat necrosis of the newborn (SCFN) is an uncommon panniculitis of neonates. Although SCFN is a self-limited condition, recognition of this entity is important, as affected infants require monitoring for associated hypercalcemia or other complications. SCFN generally has a good outcome, with spontaneous resolution of skin lesions over weeks to months. However, death from hypercalcemia has been reported in a few infants with SCFN.

Subcutaneous fat necrosis of the newborn: a pictorial essay of an under-recognized entity.

Subcutaneous fat necrosis of the newborn is a self-limited disorder predominantly affecting full-term and post-term neonates during the first 6weeks after birth. Subcutaneous fat necrosis can be focal or multifocal and affect one or both sides with a predilection for areas of pressure in certain anatomical areas. Subcutaneous fat necrosis of the newborn is associated with perinatal asphyxia and other neonatal and maternal risk factors. Subcutaneous fat necrosis of the newborn presents as a self-limited area of dermal edema followed by indurated subcutaneous plaques, or nontender and mobile nodules, sometimes with skin discoloration [1-3]. The diagnosis is based on the child's history and physical examination, but when in doubt, imaging is helpful. US is the imaging modality of choice to confirm the diagnosis of subcutaneous fat necrosis of the newborn because it provides the best resolution of superficial lesions, requires no sedation and lacks ionizing radiation. US can also help evaluate and characterize other pathologies affecting the superficial subcutaneous soft tissues at this age. Familiarity with subcutaneous fat necrosis of the newborn is important to make a prompt and precise diagnosis and avoid unnecessary imaging tests or invasive procedures.

Hypercalcemia and Nephrocalcinosis in an Infant with Subcutaneous Fat Necrosis: A Rare but Potential Serious Clinical Condition

Background: Subcutaneous fat necrosis of the newborn (SCFN) is a panniculitis characterized by the presence of violaceous subcutaneous nodules and indurated plaques on the back, buttocks, proximal extremities, or cheeks. It is a self-limiting benign condition sometimes associated with hypercalcemia that can lead to serious complications such as seizures, failure to thrive and renal failure. It usually develops in full term neonates who experienced some perinatal stress. The literature shows that hypercalcemia is found in nearly 51% of infants, with 95% of the infants developing it within 60 days of onset of skin lesions.
 Clinical Description: In this case, we describe a full-term female infant presented to us with failure to thrive at 2 months of age with a postnatal history of meconium aspiration syndrome. On further evaluation, child was found to have hypercalcemia, anemia and bilateral nephrocalcinosis.
 Management & Outcome: The clinical findings and lab investigations were consistent with subcutaneous fat necrosis with hypercalcemia as its main complication. Child was successfully treated with oral corticosteroids.
 Conclusion: Being a rare clinical condition, it is important to consider it as a differential diagnosis in infants with significant perinatal stress and hence this case report.

Subcutaneous fat necrosis of newborn - A rare case report of lobular panniculitis in a neonate

Subcutaneous fat necrosis of newborn is a rare cutaneous disorder affecting neonates. It usually presents as subcutaneous nodules or plaques, within the first few weeks of life, following an eventful delivery. It is characterized by hypercalcemia, which may present with lethargy, irritability, hypotonia and dehydration, mimicking sepsis. Histopathology is proven to be the gold standard in diagnosis with characteristic lobular panniculitis, mixed inflammatory cell infiltrate and radially arranged crystals. This needs to be differentiated from other causes of lobular panniculitis, as early diagnosis and treatment to prevent long‑term complications are advocated. Education of parents regarding the disease and danger signs of hypercalcemia and weekly monitoring of serum calcium is recommended. Treatment based on rehydration, dietary vitamin D and calcium restriction, Furosemide and prednisolone are considered. We have discussed a case of subcutaneous fat necrosis, in an 8-week-old male baby.Key Messages: Subcutaneous fat necrosis is an important differential in neonates presenting with palpable subcutaneous nodules, along with sclerema neonatorum. Severe complications like hypercalcemia should be detected early and managed aggressively to prevent morbidities and mortalities associated with it. Symptomatic management, use of calcium lowering drugs and regular monitoring of calcium levels are recommended.

Atypical facial presentation of subcutaneous fat necrosis of the newborn.

Subcutaneous fat necrosis of the newborn (SCFN) is a rare self-limiting panniculitis. It is thought to be associated with perinatal hypoxia and therapeutic hypothermia. It is characterised by firm subcutaneous nodules on the back, shoulder and arms. We present a rare facial presentation of SCFN in a 4-week-old infant with no history of therapeutic cooling. She presented with a discrete right cheek mass with no overlying skin changes. We present the diagnostic challenge and undertake a review of the literature. SCFN is an important differential diagnosis in a neonate with subcutaneous facial lesions. SCFN can be complicated by metabolic derangements including hypercalcaemia.

A Case Report and Anesthetic Considerations in Subcutaneous Fat Necrosis of the Newborn

Subcutaneous fat necrosis of the newborn (SCFN) is an uncommon, self-limiting panniculitis generally diagnosed in the first few weeks of extrauterine life in term or postterm infants subjected to perinatal physiologic stress. Hallmarks of the process include dramatic hypercalcemia without identifiable cause that may be associated with renal disease, seizures, and death. Herein, we describe the anesthetic approach in an 11-week-old infant, including perioperative laboratory testing, management of hypercalcemia, and intraoperative considerations.

Subcutaneous Fat Necrosis of the Newborn Secondary to Sepsis: A Case Report

Subcutaneous fat necrosis of the newborn (SCFN) is a rare noninfectious type of panniculitis, which primarily affects term and postterm infants. It is usually a benign, self-limiting condition, but in rare cases can be complicated by hypercalcemia, hypoglycemia, thrombocytopenia, etc. We report a case of SCFN in a 4-week-old male infant, treated successfully without complications.

Subcutaneous Fat Necrosis of the Newborn.

Subcutaneous Fat Necrosis of the Newborn.

Subcutaneous fat necrosis of the newborn: clinical and histopathological correlation

Subcutaneous fat necrosis of the newborn is a rare benign panniculitis found in term and post-term neonates. Diagnosis is based on clinical characteristics and specific alterations in the adipocytes, detected by anatomical pathology. Subcutaneous fat necrosis of the newborn can occur in uncomplicated pregnancy and childbirth. However, perinatal complications such as asphyxia, hypothermia, seizures, preeclampsia, meconium aspiration, and even whole-body cooling used in newborns with perinatal hypoxia/anoxia may be associated with this entity.

Neutrophil-rich subcutaneous fat necrosis of the newborn: A potential mimic of infection

The inflammatory infiltrate seen in biopsy specimens obtained from patients with subcutaneous fat necrosis of the newborn (SCFN) has classically been described as consisting mostly of histiocytes. However, we encountered patients with SCFN whose biopsy specimens revealed mostly neutrophils, prompting infection to be an initial consideration. We sought to describe cases of SCFN in which neutrophils formed the majority of the infiltrate at our institution and in the literature. We performed a retrospective analysis of patients with SCFN reported at our institution and a literature review of SCFN. Thirteen cases of SCFN were identified at our institution. In 2 of 13 cases, neutrophils composed >75% of the inflammatory infiltrate, and both lesions were 1day old. From the literature review, neutrophils were mentioned as a component of the infiltrate in 10 of 124 cases, but in none were neutrophils described as forming the majority of the infiltrate. This study is limited by its retrospective nature and small sample size. Neutrophils can comprise most of the inflammatory cells in patients with SCFN, especially early in the course of the disease. This variant of SCFN can be easily mistaken for infection.

Subcutaneous fat necrosis in newborn: case report

Subcutaneous fat necrosis of the new-born (SCFN) is an unusual form of panniculitis, with few cases described in medical literature. The disease affects new-borns at term or post-term, with normal general health. We describe a case of 5 day old new-born affected by the disease since birth. Also, we discuss diagnostic approach and the differential diagnosis.

Subcutaneous Fat Necrosis of Newborn (SCFN) Associated with Head Cooling in an Asphyxiated Newborn-A case report

Abstract not available DOI: http://dx.doi.org/10.3329/bjch.v38i2.21146 Bangladesh J Child Health 2014; VOL 38 (2) : 101-103

Subcutaneous Fat Necrosis of the Newborn: Report of Five Cases

Subcutaneous fat necrosis of the newborn (SCFN) is a rare, self-limited disorder of the panniculus which appears in the first few weeks of life. SCFN generally follows an uncomplicated course. However, there are important complications for which the patient must be regularly monitored, including thrombocytopenia, hypoglycemia, hypertriglyceridemia, and most importantly, hypercalcemia. We report five infants with SCFN. All children were born at term. The onset of lesions was between 1day and 20days after birth. The back was the most frequent location. Birth hypoxia was the most frequent risk factor. Complications included hypercalcemia, hypoglycemia, and metastatic calcifications (disseminated subcutaneous calcifications, nephrocalcinosis, and myocardial calcifications). This study provides the first case of SCFN in the context of hypoxic encephalopathy and refractory septic shock that required extracorporeal membrane oxygenation (ECMO).

Surgical management of subcutaneous fat necrosis of the newborn required due to a lack of improvement: a very rare case

Subcutaneous fat necrosis of the newborn (ScFN) is an uncommon and transient disease characterized by defined areas of fat necrosis and overlying cutaneous nodule lesions. It usually becomes apparent within the first 6 weeks of life in full-term or post-term infants. It is caused by generalized and/or local tissue hypoperfusion. The skin lesions of ScFN tend generally to improve spontaneously in a few weeks. We present a full-term newborn with birth distress. After therapeutic hypothermia, she presented voluminous and numerous subcutaneous fat necrosis with extensive calcifications. Surgical management was decided at her ninth month because of a total lack of regression. Hypercalcaemia, the most threatening complication, appeared only after this delayed surgery.

A Case of Subcutaneous Fat Necrosis of the Newborn with Hypoglycemia and Meconium Aspiration Syndrome

환아 : 김◯선아기, 생후 1일, 여아 주소 : 출생 직후 발생한 호흡곤란 출생력 및 현병력 : 환아는 타원에서 재태 기간 40주 0 일에 특별한 분만 손상 없이 제왕절개술로 출생하였으며 출생 체중은 2,860 g (10-25백분위수)이었다. 아프가 점 수는 1분 8점, 5분 8점으로 양호하였으나, 출생 시 양수가 태변 착색을 보였고 이후 호흡곤란 증상을 보여 기관 삽관 후 양압환기를 시행하며 본원 신생아 집중 치료실로 입원 하였다. 산모 병력 및 가족력 : 임신성 당뇨 외에 특이 사항 없음. 피하지방괴사(subcutaneous fat necrosis)는 다양한 연령층에서 나타날 수 있지만 신생아에서 드문 질환으로, 신생아에서는 분만 손상, 가사(birth asphyxia)와 같은 저 산소증, 저체온 치료(therapeutic hypothermia), 저혈당 증, 산모의 임신성 당뇨병과 고혈압 등의 위험 요인을 가지 는 만삭아에서 출생 후 수주 이내에 잘 발생한다. 지방 패드(fat pad)가 있는 사지, 등, 엉덩이, 허벅지 등에 주로 발 생하는 한 개 혹은 여러 개의 경계가 뚜렷한 압통을 동반한 홍반성, 경화성 피하 결절(nodules) 및 판(plaque)을 특징 으로 하는 지방층염의 드문 형태로 예후가 좋아 대부분 수 주 내지 수개월 후 소실된다. 합병증으로는 고칼슘혈증, 통 증, 지질이상, 신부전, 피하 위축 들이 있다. 국내에서는 신 저혈당증과 태변 흡인 증후군을 보인 신생아에서 나타난 피하지방괴사 1례

Subcutaneous fat necrosis of the newborn: clinical manifestations in two cases

Subcutaneous fat necrosis of the newborn is an unusual form of panniculitis, with few cases described in medical literature. The disease affects newborns at term or post-term, with normal general health. We describe two cases of newborns affected by the disease. One of them already had lesions since birth. Also, we discuss the use of puncture for diagnostic assistance.

Biphosphonate therapy in subcutaneous fat necrosis with hypercalcemia and nephrocalcinosis in the newborn

Subcutaneous fat necrosis of the newborn (SCFN) is a rare disorder. We report the case of a newborn with SCFN which was complicated by hypercalcaemia and nephrocalcinosis. The hypercalcaemia was treated with hyper hydration, furosemide, and corticosteroids but in vein. Finally the patient was given biphosphonate which normalized calcium levels.

Is Therapeutic Hypothermia Real Cause of Subcutaneous Fat Necrosis in Newborns?

Sir,We read with great interest the article by Sivanandanet al. [1], who reported subcutaneous fat necrosis (SFN)in a newborn suffering from perinatal asphyxia who wastreated with total body cooling. In their report [1], it issuggested that therapeutic body cooling increases the riskof SFN and renal complications. Recently, we reported acase of SFN, which was complicated by hypercalcemia,due to perinatal hypoxic injury [2]. Unlike case of Siva-nandan et al. [1], our patient did not undergo hypothermiatherapy. Hence, we would like to make some comments ontheir report.Firstly, the authors have reported that as if SFN is mainlycaused by therapeutic hypothermia in newborns. It should beemphasized that neonatal SFN is primarily caused by someperinatal conditions such as birth asphyxia, cord accidents,meconium aspiration [1, 2], but therapeutic hypothermia mayfacilitate this process [3]. Therefore, in the reported case, itseems likely that SFN has been caused by perinatal asphyxiasecondary to abruptio placenta. Hence, title of the article“Subcutaneous fat necrosis as a complication of therapeutichypothermia in a term neonate” is not consistent with thereported case.Secondly, therapeutic hypothermia may cause renal dam-age [4]. However, hypoxic-ischemic injury itself is the maincause of renal injury in these cases.Thirdly, in the present case, the skin lesions have beenreported only in areas where the skin was in contact with thecooling blanket [1]. Actually, in SFN, erythematous nodulesand plaques are mainly located over bony prominences suchas the back, thighs, arms and buttocks [2, 5]. Therefore, it iscontroversial whether total body cooling treatment is themajor risk factor of SFN in the reported case.In conclusion, SFN of the newborn is a disorder of theadipose tissue, mostly affecting full-term or post-terminfants who experience perinatal distress. Nevertheless,though perinatal hypoxic-ischemic event is the real causeof SFN, hypothermia may facilitate its occurrence. In addi-tion, the patients with SFN should be closely monitored fordeveloping other problems like renal complications relatedto hypoxic-ischemic injury.References