Clinical Outcomes of Subcutaneous Fat Necrosis of the Newborn

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• This single-center retrospective study involving 32 neonates with subcutaneous fat necrosis of the newborn (SCFN) found that all the infants had hypercalcemia. Overall, 3 patients developed clinical symptoms of hypercalcemia, 2 developed nephrocalcinosis, 2 required hospitalization, and 1 developed acute kidney injury. All patients who developed symptomatic hypercalcemia had peak ionized calcium levels greater than 1.5 mmol/L.
• This study found that all infants with SCFN had hypercalcemia. A care algorithm is provided.

–  Kelly B. Scarberry, MD

Written by

 

 

Sarah L. Chamlin MD

Management of hypercalcemia associated with subcutaneous fat necrosis of the newborn is a challenge, even for seasoned pediatric dermatologists. Dr. Siegel and I designed this study to guide the evaluation and management of this rare disorder. All 29 infants in our study with laboratory testing had hypercalcemia, and 6 infants (20%) had complications of hypercalcemia, including symptoms, poor feeding and irritability, and nephrocalcinosis. Figure 2 includes a valuable algorithm for monitoring ionized calcium based on initial levels and when to escalate care based on symptoms or ionized calcium levels. 

Abstract

OBJECTIVE

To describe the clinical and laboratory outcomes of infants with subcutaneous fat necrosis of the newborn (SCFN) and propose a care algorithm.

METHODS

This single-center, retrospective study of infants diagnosed with SCFN at Ann & Robert H. Lurie Children's Hospital of Chicago from 2009 to 2019.

RESULTS

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 3 months of age.

CONCLUSION

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 (>6 months) we suggest coordinated care with endocrinology or nephrology, consider hospitalization, and urinary system ultrasound.

Pediatric Dermatology

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

Pediatr Dermatol 2022 Dec 21;[EPub Ahead of Print], LH Siegel, C Fraile Alonso, CFR Tuazon, AJ Mancini, LL Kruse, JL Miller, AM Wagner, D Yun, BM Kenner-Bell, AS Paller, SL Chamlin 

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Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
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