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Frank L, Brandt S, Wabitsch M. Subcutaneous fat necrosis in newborns: a systematic literature review of case reports and model of pathophysiology. Mol Cell Pediatr 2022; 9:18. [PMID: 36427118 PMCID: PMC9700527 DOI: 10.1186/s40348-022-00151-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 11/09/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Subcutaneous fat necrosis of the newborn (SCFN) is a rare disease occurring in the first days of life. Characteristically, the infants show hard nodules in subcutaneous tissue, purple or erythematous in color and appear on the upper back, cheeks, buttocks and limbs. In most cases, SCFN is a self-limiting disease, as the nodules disappear in up to 6 months. A severe complication associated with SCFN is hypercalcaemia. Pathophysiological mechanisms causing SCFN or associated hypercalcaemia are not fully understood yet. METHODS A systematic literature research including the six biggest databases for medical research has been used to identify all published case reports of SCFN. N = 206 publications has been identified containing n = 320 case reports. All cases have been classified into four subgroups (depending on reported serum-calcium-level): hypercalcaemia, normocalcaemia, hypocalcaemia or no information given. Reported maternal factors, birth characteristics, details about SCFN, diagnostics, therapy and long-term observations have been extracted from publications. RESULTS This is the first systematic literature research that summed up all published cases of SCFN from 1948 up to 2018. Information about serum calcium level was given in 64.3% of the cases. From those, the majority showed hypercalcaemia (70.5%) (normocalcaemia 25.1%, hypocalcemia 4.3%). 89.3% of newborns with hypercalcaemia showed suppressed levels of the parathormone. Maternal gestational diabetes, maternal hypertensive diseases during pregnancy, macrosomia (> 4000g), asphyxia and therapeutic hypothermia are risk factors for SCFN. Histological findings showed a granulomatous inflammation in 98% of cases. CONCLUSION We identified that maternal, birth characteristics and therapeutic measures are probably risk factors for SCFN. These risk factors should be taken into account within the care of neonates.
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Affiliation(s)
- Leonie Frank
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics and Adolescent Medicine, University Medical Center Ulm, Ulm, Germany
- Department of Orthopaedics and Trauma Surgery, Oberschwaben Clinic Wangen im Allgäu, Wangen im Allgäu, Germany
| | - Stephanie Brandt
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics and Adolescent Medicine, University Medical Center Ulm, Ulm, Germany
| | - Martin Wabitsch
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics and Adolescent Medicine, University Medical Center Ulm, Ulm, Germany.
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2
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Walden AR, Rowell A, Chowdhary V, Crawford B, Shukla A. Preterm Infant with Persistent Hypercalcemia in the Absence of Cutaneous Nodules. Neoreviews 2022; 23:774-777. [PMID: 36316255 DOI: 10.1542/neo.23-10-e774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
- Alyssa R Walden
- University of Arkansas for Medical Sciences, Little Rock, AR
- Arkansas Children's Hospital, Little Rock, AR
| | - Amy Rowell
- University of Arkansas for Medical Sciences, Little Rock, AR
- Arkansas Children's Hospital, Little Rock, AR
| | - Vikas Chowdhary
- University of Arkansas for Medical Sciences, Little Rock, AR
- Arkansas Children's Hospital, Little Rock, AR
| | - Brendan Crawford
- University of Arkansas for Medical Sciences, Little Rock, AR
- Arkansas Children's Hospital, Little Rock, AR
| | - Ankita Shukla
- University of Arkansas for Medical Sciences, Little Rock, AR
- Arkansas Children's Hospital, Little Rock, AR
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3
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Martinelli S, Pitea M, Gatelli IF, Raouf T, Barera G, Vitelli O. Safety and Efficacy of Pamidronate in Neonatal Hypercalcemia Caused by Subcutaneous Fat Necrosis: A Case Report. Front Pediatr 2022; 10:845424. [PMID: 35573963 PMCID: PMC9096199 DOI: 10.3389/fped.2022.845424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 03/29/2022] [Indexed: 12/12/2022] Open
Abstract
Subcutaneous fat necrosis of the newborn (SCFN) is a panniculitis that develops in fatty areas after fetal or perinatal distress. Prognosis is generally good with complete regression, but it can be complicated by metabolic abnormalities like hypoglycemia, hypertriglyceridemia, thrombocytopenia, and also potentially life-threatening hypercalcemia. Treatments have included hydration, furosemide and corticosteroids. These treatments can be prolonged for several days and can have complications such as nephrocalcinosis. Use of bisphosphonates has been rarely reported in newborn. We describe a case of severe hypercalcemia complicating subcutaneous fat necrosis in a newborn successfully treated by a single dose of pamidronate after having obtained partial response by therapy with hyperhydration, furosemide and hydrocortisone. When high levels of calcium do not respond to first line therapy with hyperhydration and diuretic therapy, bisphosphonates treatment could be considered a valid choice to treat hypercalcemia and to avoid corticosteroids. Further studies are needed to understand if pamidronate and other bisphosphonates can be considered the first choice in hypercalcemia due to SCFN.
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Affiliation(s)
- Stefano Martinelli
- Neonatal Intensive Care Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Marco Pitea
- Pediatric and Neonatal Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | | | - Tara Raouf
- Vita-Salute San Raffaele University, Milan, Italy
| | - Graziano Barera
- Pediatric and Neonatal Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | - Ottavio Vitelli
- Neonatal Intensive Care Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
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4
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Sandoval Karamian AG, Mercimek-Andrews S, Mohammad K, Molloy EJ, Chang T, Chau V, Murray DM, Wusthoff CJ. Neonatal encephalopathy: Etiologies other than hypoxic-ischemic encephalopathy. Semin Fetal Neonatal Med 2021; 26:101272. [PMID: 34417137 DOI: 10.1016/j.siny.2021.101272] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Neonatal encephalopathy (NE) describes the clinical syndrome of a newborn with abnormal brain function that may result from a variety of etiologies. HIE should be distinguished from neonatal encephalopathy due to other causes using data gathered from the history, physical and neurological exam, and further investigations. Identifying the underlying cause of encephalopathy has important treatment implications. This review outlines conditions that cause NE and may be mistaken for HIE, along with their distinguishing clinical features, pathophysiology, investigations, and treatments. NE due to brain malformations, vascular causes, neuromuscular causes, genetic conditions, neurogenetic disorders and inborn errors of metabolism, central nervous system (CNS) and systemic infections, and toxic/metabolic disturbances are discussed.
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Affiliation(s)
- A G Sandoval Karamian
- Children's Hospital of Philadelphia, Division of Neurology, 3501 Civic Center Blvd Office 1200.12, Philadelphia, PA, 19104, USA.
| | - S Mercimek-Andrews
- Biochemical Geneticist, Department of Medical Genetics, University of Alberta, 8-39 Medical Sciences Building, 8613 - 144 Street, Edmonton, T6G 2H7, Alberta, Canada.
| | - K Mohammad
- Cumming School of Medicine, University of Calgary, Alberta Children's Hospital, Room B4-286, 28 Oki drive NW, Calgary, AB, T3B 6A8, Canada.
| | - E J Molloy
- Trinity College, the University of Dublin, Trinity Translational Medicine Institute, Dublin, Ireland; Children's Health Ireland at Tallaght and Crumlin & and Coombe Women's and Infants University Hospital, Dublin, Ireland; Trinity Research in Childhood Centre (TRiCC), Trinity Academic Centre, Tallaght University Hospital, Dublin 24, Ireland.
| | - T Chang
- George Washington University School of Medicine & Health Sciences, Washington, DC, 20010, USA; Neonatal Neurology Program, Children's National Hospital, 111 Michigan Ave NW, Washington, DC, 20010, USA.
| | - Vann Chau
- Neurology, Neonatal Neurology Program, The Hospital for Sick Children, 555 University Avenue, Toronto ON, M5G 1X8, Canada.
| | - D M Murray
- Deptartment of Paediatric and Child Health, University College Cork, ARm 2.32, Paediatric Academic Unit, Floor 2, Seahorse Unit, Cork University Hospital, Wilton, Cork, T12 DCA4, Ireland.
| | - Courtney J Wusthoff
- Division of Child Neurology, Division of Pediatrics- Neonatal and Developmental Medicine, Stanford Children's Health, 750 Welch Road, Suite 317, Palo Alto, CA, 94304 USA.
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5
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Edafe O, Stenton S, Cohen MC, Beasley N, Carr S. Atypical facial presentation of subcutaneous fat necrosis of the newborn. Ann R Coll Surg Engl 2021; 103:e234-e237. [PMID: 34192496 DOI: 10.1308/rcsann.2021.0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
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.
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Affiliation(s)
- O Edafe
- Sheffield Teaching Hospitals NHS Foundation Trust, UK
| | - S Stenton
- Sheffield Children's NHS Foundation Trust, UK
| | - M C Cohen
- Sheffield Children's NHS Foundation Trust, UK.,The University of Sheffield, UK
| | - N Beasley
- Sheffield Teaching Hospitals NHS Foundation Trust, UK.,Sheffield Children's NHS Foundation Trust, UK
| | - S Carr
- Sheffield Teaching Hospitals NHS Foundation Trust, UK.,Bradford Teaching Hospitals NHS Foundation Trust, UK
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6
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Chrysaidou K, Sargiotis G, Karava V, Liasis D, Gourvas V, Moutsanas V, Christoforidis A, Stabouli S. Subcutaneous Fat Necrosis and Hypercalcemia with Nephrocalcinosis in Infancy: Case Report and Review of the Literature. CHILDREN (BASEL, SWITZERLAND) 2021; 8:children8050374. [PMID: 34065153 PMCID: PMC8151818 DOI: 10.3390/children8050374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 05/04/2021] [Accepted: 05/06/2021] [Indexed: 11/18/2022]
Abstract
Subcutaneous fat necrosis is an uncommon benign panniculitis affecting more commonly full-term newborns. It has been associated with birth asphyxia and meconium aspiration, as well as therapeutic hypothermia. Although the prognosis is generally favorable, complications such as hypercalcemia, thrombocytopenia, hypoglycemia and hypertriglyceridemia may complicate its course. The most serious complication is hypercalcemia that may reach life threatening levels and can be associated with nephrocalcinosis. We thereby describe a case of subcutaneous fat necrosis after therapeutic hypothermia, which presented with late-onset refractory severe hypercalcemia and persistent nephrocalcinosis during the follow up of the patient. Due to the risk of the development of chronic kidney disease, we highlight the importance of careful monitoring of hypercalcemia and review the literature of subcutaneous fat necrosis related to nephrocalcinosis.
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Affiliation(s)
- Katerina Chrysaidou
- 1st Department of Pediatrics, Aristotle University of Thessaloniki, Hippokratio General Hospital Thessaloniki, 54642 Thessaloniki, Greece; (K.C.); (G.S.); (V.K.); (A.C.)
- Department of Pediatrics, St Luke’s Hospital, Panorama, 55236 Thessaloniki, Greece; (D.L.); (V.G.)
| | - Georgios Sargiotis
- 1st Department of Pediatrics, Aristotle University of Thessaloniki, Hippokratio General Hospital Thessaloniki, 54642 Thessaloniki, Greece; (K.C.); (G.S.); (V.K.); (A.C.)
| | - Vasiliki Karava
- 1st Department of Pediatrics, Aristotle University of Thessaloniki, Hippokratio General Hospital Thessaloniki, 54642 Thessaloniki, Greece; (K.C.); (G.S.); (V.K.); (A.C.)
| | - Dimitrios Liasis
- Department of Pediatrics, St Luke’s Hospital, Panorama, 55236 Thessaloniki, Greece; (D.L.); (V.G.)
| | - Victor Gourvas
- Department of Pediatrics, St Luke’s Hospital, Panorama, 55236 Thessaloniki, Greece; (D.L.); (V.G.)
| | | | - Athanasios Christoforidis
- 1st Department of Pediatrics, Aristotle University of Thessaloniki, Hippokratio General Hospital Thessaloniki, 54642 Thessaloniki, Greece; (K.C.); (G.S.); (V.K.); (A.C.)
| | - Stella Stabouli
- 1st Department of Pediatrics, Aristotle University of Thessaloniki, Hippokratio General Hospital Thessaloniki, 54642 Thessaloniki, Greece; (K.C.); (G.S.); (V.K.); (A.C.)
- Correspondence:
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7
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Lehrer B, Pronko K, Burek AG. Ulcerated Arm Lesion in a 10-day-old Girl. Pediatr Rev 2021; 42:S93-SS96. [PMID: 33386373 DOI: 10.1542/pir.2019-0267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
| | - Kyle Pronko
- Medical College of Wisconsin, Milwaukee, WI.,Children's Wisconsin, Milwaukee, WI
| | - Alina G Burek
- Medical College of Wisconsin, Milwaukee, WI.,Children's Wisconsin, Milwaukee, WI
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8
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Chesover AD, Harrington J, Mahmud FH. Pamidronate as first-line treatment of hypercalcemia in neonatal subcutaneous fat necrosis: A case series. Paediatr Child Health 2019; 26:e52-e56. [PMID: 33542779 DOI: 10.1093/pch/pxz141] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 09/12/2019] [Indexed: 11/14/2022] Open
Abstract
Background Subcutaneous fat necrosis (SCFN) can be complicated by severe hypercalcemia, which is frequently asymptomatic. Nephrocalcinosis is associated with hypercalcemia and, in other clinical settings, has been linked to furosemide and glucocorticoid use. First-line bisphosphonate therapy treating hypercalcemia in neonatal SCFN is not well described. Objectives To describe the biochemical changes and risk of nephrocalcinosis in infants with hypercalcemia, secondary to neonatal SCFN, treated with initial pamidronate. Methods A retrospective chart review of five infants treated with initial pamidronate and without furosemide or glucocorticoids. Data were collected on the following: timing of presentation, therapeutic response, and presence of nephrocalcinosis. Results Hypercalcemia resolved after 2.8±1.7 days; this is compared to 7.6±2.8 days from previously reported cases utilising alternative therapies (P=0.012). There were no episodes of rebound hypercalcemia or hypocalcemia. Nephrocalcinosis was present in four of five cases. When including published cases, age at diagnosis was associated with presenting serum calcium (P=0.003) and nephrocalcinosis was associated with higher serum calcium (P=0.014) and time from SCFN to hypercalcemia diagnosis (P=0.002). Conclusions This retrospective case series demonstrates that first-line pamidronate treatment was effective and safe in the resolution of hypercalcemia. Nephrocalcinosis was observed, despite the avoidance of furosemide and glucocorticoid therapy, and associated with greater disease severity and duration of hypercalcemia.
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Affiliation(s)
- Alexander D Chesover
- Division of Endocrinology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario
| | - Jennifer Harrington
- Division of Endocrinology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario
| | - Farid H Mahmud
- Division of Endocrinology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario
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9
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Alsaleem M, Saadeh L, Elberson V, Kumar VHS. Subcutaneous fat necrosis, a rare but serious side effect of hypoxic-ischemic encephalopathy and whole-body hypothermia. J Perinat Med 2019; 47:986-990. [PMID: 31586967 DOI: 10.1515/jpm-2019-0172] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 09/17/2019] [Indexed: 11/15/2022]
Abstract
Objective To describe the clinical characteristics and risk factors in infants with subcutaneous fat necrosis (SFN) following therapeutic hypothermia for hypoxic-ischemic encephalopathy (HIE). Methods A case-control study was performed by a retrospective chart review of infants with moderate or severe HIE admitted to a level IV regional perinatal center and who underwent whole-body cooling. Results A total of 14 (8.1%) of 171 infants with moderate or severe HIE who underwent whole-body cooling developed SFN during hospitalization. There were more females [71% (10/14)] and large-for-gestational age (LGA) infants [28% (4/14)] in the SFN group vs. 36% females (57/157) and 8% LGA infants (13/157) in the group without SFN (P-values of 0.009 and 0.015, respectively). The mean lowest platelet count was lower 108 ± 55 109/L vs. 146 ± 62 109/L and the mean highest calcium level was higher 11.3 ± 2.5 vs. 10.6 ± 0.8 mg/dL in infants with SFN vs. infants without SFN, respectively (P-values of 0.0078 and 0.006, respectively). Distribution of skin lesions followed distinctive patterns representing the areas with direct contact with the cooling blanket. One infant developed severe, life-threatening hypercalcemia that required aggressive management, including diuretics, corticosteroids and bisphosphonates. Conclusion Although SFN is a rare complication of therapeutic hypothermia, it can be a life-threatening condition if complicated by severe hypercalcemia. Infants who undergo therapeutic hypothermia for HIE need regular skin examinations to evaluate for SFN. If SFN is identified, monitoring of serum calcium levels to prevent life-threatening hypercalcemia is recommended.
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Affiliation(s)
- Mahdi Alsaleem
- Department of Pediatrics, Division of Neonatology, Children's Mercy Hospital, University of Kansas, 3600 E Harry St., Wichita, 67218 KS, USA
| | - Lina Saadeh
- Pediatric Endocrinology, The State University of New York, University at Buffalo, Buffalo, NY, USA
| | - Valerie Elberson
- Neonatal-Perinatal Medicine, The State University of New York, University at Buffalo, Buffalo, NY, USA
| | - Vasantha H S Kumar
- Neonatal-Perinatal Medicine, The State University of New York, University at Buffalo, Buffalo, NY, USA
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10
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Affiliation(s)
| | - Avni N Shah
- Department of Pediatric Endocrinology, McGovern Medical School at UT Health, Houston, TX
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11
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Stefanko NS, Drolet BA. Subcutaneous fat necrosis of the newborn and associated hypercalcemia: A systematic review of the literature. Pediatr Dermatol 2019; 36:24-30. [PMID: 30187956 DOI: 10.1111/pde.13640] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Subcutaneous fat necrosis of the newborn is an uncommon disorder, and although usually benign, associated hypercalcemia can lead to complications such as failure to thrive and renal failure. Many sources suggest screening for hypercalcemia for 6 months following resolution of skin lesions, but little data are available to support this recommendation. This study examines existing published literature to better guide practitioners regarding screening evaluations of asymptomatic patients with subcutaneous fat necrosis. A systematic review of the literature was conducted using a PubMed English literature search. Data from case reports and case series were collected regarding the presence of hypercalcemia and associated complications, birth history, and age of onset/resolution of skin lesions and laboratory abnormalities. Approximately half (51%) of infants reported had hypercalcemia. Most (77%) developed detectable hypercalcemia within 30 days of skin lesion onset, and 95% developed detectable hypercalcemia within 60 days of skin lesion onset. Hypercalcemia was detected in only 4% of patients > 70 days following onset of skin lesions. Seventy-six percent had resolution of hypercalcemia within 4 weeks of detection. Hypercalcemia was more prevalent in full-term vs pre-term infants (P-value = 0.054), and higher birthweight was significantly associated with an increased risk of developing hypercalcemia (P-value = 0.022). Although gestational age trended toward significance, the only statistically significant clinical feature predicting the development of hypercalcemia was higher birthweight. Current recommendations for laboratory monitoring are not evidence-based, and this study provides interim data to guide practitioners until prospective, randomized controlled trials are conducted.
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Affiliation(s)
- Nicole S Stefanko
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Beth A Drolet
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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12
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Fajgenbaum K, Zeitany A, Googe PB, Morrell DS, McShane D. Firm, Indurated Plaques After Therapeutic Hypothermia. Clin Pediatr (Phila) 2018; 57:1468-1471. [PMID: 29985047 DOI: 10.1177/0009922818785992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Alexandra Zeitany
- 2 Department of Dermatology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Paul B Googe
- 2 Department of Dermatology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Dean S Morrell
- 2 Department of Dermatology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Diana McShane
- 2 Department of Dermatology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
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13
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Bikle DD, Patzek S, Wang Y. Physiologic and pathophysiologic roles of extra renal CYP27b1: Case report and review. Bone Rep 2018; 8:255-267. [PMID: 29963603 PMCID: PMC6021194 DOI: 10.1016/j.bonr.2018.02.004] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 02/06/2018] [Accepted: 02/23/2018] [Indexed: 01/13/2023] Open
Abstract
Although the kidney was initially thought to be the sole organ responsible for the production of 1,25(OH)2D via the enzyme CYP27b1, it is now appreciated that the expression of CYP27b1 in tissues other than the kidney is wide spread. However, the kidney is the major source for circulating 1,25(OH)2D. Only in certain granulomatous diseases such as sarcoidosis does the extra renal tissue produce sufficient 1,25(OH)2D to contribute to the circulating levels, generally associated with hypercalcemia, as illustrated by the case report preceding the review. Therefore the expression of CYP27b1 outside the kidney under normal circumstances begs the question why, and in particular whether the extra renal production of 1,25(OH)2D has physiologic importance. In this chapter this question will be discussed. First we discuss the sites for extra renal 1,25(OH)2D production. This is followed by a discussion of the regulation of CYP27b1 expression and activity in extra renal tissues, pointing out that such regulation is tissue specific and different from that of CYP27b1 in the kidney. Finally the physiologic significance of extra renal 1,25(OH)2D3 production is examined, with special focus on the role of CYP27b1 in regulation of cellular proliferation and differentiation, hormone secretion, and immune function. At this point the data do not clearly demonstrate an essential role for CYP27b1 expression in any tissue outside the kidney, but several examples pointing in this direction are provided. With the availability of the mouse enabling tissue specific deletion of CYP27b1, the role of extra renal CYP27b1 expression in normal and pathologic states can now be addressed definitively.
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Affiliation(s)
- Daniel D Bikle
- Department of Medicine, Endocrine Research Unit, Veterans Affairs Medical Center, University of California San Francisco, United States
| | - Sophie Patzek
- Department of Medicine, Endocrine Research Unit, Veterans Affairs Medical Center, University of California San Francisco, United States
| | - Yongmei Wang
- Department of Medicine, Endocrine Research Unit, Veterans Affairs Medical Center, University of California San Francisco, United States
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14
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Stokes VJ, Nielsen MF, Hannan FM, Thakker RV. Hypercalcemic Disorders in Children. J Bone Miner Res 2017; 32:2157-2170. [PMID: 28914984 PMCID: PMC5703166 DOI: 10.1002/jbmr.3296] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 09/07/2017] [Accepted: 09/13/2017] [Indexed: 12/20/2022]
Abstract
Hypercalcemia is defined as a serum calcium concentration that is greater than two standard deviations above the normal mean, which in children may vary with age and sex, reflecting changes in the normal physiology at each developmental stage. Hypercalcemic disorders in children may present with hypotonia, poor feeding, vomiting, constipation, abdominal pain, lethargy, polyuria, dehydration, failure to thrive, and seizures. In severe cases renal failure, pancreatitis and reduced consciousness may also occur and older children and adolescents may present with psychiatric symptoms. The causes of hypercalcemia in children can be classified as parathyroid hormone (PTH)-dependent or PTH-independent, and may be congenital or acquired. PTH-independent hypercalcemia, ie, hypercalcemia associated with a suppressed PTH, is commoner in children than PTH-dependent hypercalcemia. Acquired causes of PTH-independent hypercalcemia in children include hypervitaminosis; granulomatous disorders, and endocrinopathies. Congenital syndromes associated with PTH-independent hypercalcemia include idiopathic infantile hypercalcemia (IIH), William's syndrome, and inborn errors of metabolism. PTH-dependent hypercalcemia is usually caused by parathyroid tumors, which may give rise to primary hyperparathyroidism (PHPT) or tertiary hyperparathyroidism, which usually arises in association with chronic renal failure and in the treatment of hypophosphatemic rickets. Acquired causes of PTH-dependent hypercalcemia in neonates include maternal hypocalcemia and extracorporeal membrane oxygenation. PHPT usually occurs as an isolated nonsyndromic and nonhereditary endocrinopathy, but may also occur as a hereditary hypercalcemic disorder such as familial hypocalciuric hypercalcemia, neonatal severe primary hyperparathyroidism, and familial isolated primary hyperparathyroidism, and less commonly, as part of inherited complex syndromic disorders such as multiple endocrine neoplasia (MEN). Advances in identifying the genetic causes have resulted in increased understanding of the underlying biological pathways and improvements in diagnosis. The management of symptomatic hypercalcemia includes interventions such as fluids, antiresorptive medications, and parathyroid surgery. This article presents a clinical, biochemical, and genetic approach to investigating the causes of pediatric hypercalcemia. © 2017 American Society for Bone and Mineral Research.
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Affiliation(s)
- Victoria J Stokes
- Academic Endocrine UnitRadcliffe Department of MedicineUniversity of OxfordOxfordUK
| | - Morten F Nielsen
- Academic Endocrine UnitRadcliffe Department of MedicineUniversity of OxfordOxfordUK
- Department of Clinical ResearchFaculty of HealthUniversity of Southern DenmarkOdenseDenmark
| | - Fadil M Hannan
- Academic Endocrine UnitRadcliffe Department of MedicineUniversity of OxfordOxfordUK
- Department of Musculoskeletal BiologyInstitute of Ageing and Chronic DiseaseUniversity of LiverpoolOxfordUK
| | - Rajesh V Thakker
- Academic Endocrine UnitRadcliffe Department of MedicineUniversity of OxfordOxfordUK
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15
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Kellar A, Tangtatco JA, Weinstein M, Saunders N. Subcutaneous Fat Necrosis of the Newborn With Initial Hypocalcemia and Familial Recurrence: A Case Report. J Cutan Med Surg 2017; 22:223-225. [DOI: 10.1177/1203475417733459] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Subcutaneous fat necrosis of the newborn (SFNN) is a rare disorder characterised by indurated plaques or nodules with or without erythema, typically distributed over the cheeks, extremities, posterior trunk, buttocks, and thighs, and appears during the first 2 weeks of life. It is commonly associated with perinatal asphyxia and, while usually self-limited, can lead to severe hypercalcemia. There is no known familial association. The present article describes a neonate with extensive disease, counterintuitive hypocalcemia, and a family history of SFNN and reviews the existing literature on SFNN.
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Affiliation(s)
- Amelia Kellar
- Division of Paediatric Medicine, Department of Paediatrics, Hospital for Sick Children, Toronto, ON, Canada
| | - Jennifer Aileen Tangtatco
- Division of Paediatric Medicine, Department of Paediatrics, Hospital for Sick Children, Toronto, ON, Canada
| | - Miriam Weinstein
- Division of Paediatric Medicine, Department of Paediatrics, Hospital for Sick Children, Toronto, ON, Canada
| | - Natasha Saunders
- Division of Paediatric Medicine, Department of Paediatrics, Hospital for Sick Children, Toronto, ON, Canada
- Child Health Evaluative Sciences, Sickkids Research Institute, Toronto, ON, Canada
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
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16
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Adashek J, Mu W, Francis J, Cohen B, Pruette C, Grossberg A, Bodurtha J. Incontinentia Pigmenti with Persistent Hypercalcemia: Case Report. Pediatr Dermatol 2016; 33:e315-7. [PMID: 27412134 DOI: 10.1111/pde.12925] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Incontinentia pigmenti (IP) is an X-linked dominant disorder that in most cases is considered lethal in males. IP affects the skin, hair, teeth, nails, eyes, and central nervous system. We report a case of persistent hypercalcemia (10.6-11.3 mg/dL) in a 19-month-old Caucasian boy with clinical IP. The proposed mechanism for his hypercalcemia is discussed.
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Affiliation(s)
- Jacob Adashek
- College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, California.
| | - Weiyi Mu
- McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Jacquelyn Francis
- McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Bernard Cohen
- Division of Pediatric Dermatology, Johns Hopkins University, Baltimore, Maryland
| | - Cozumel Pruette
- Division of Pediatric Nephrology, Johns Hopkins University, Baltimore, Maryland
| | - Annie Grossberg
- Division of Pediatric Dermatology, Johns Hopkins University, Baltimore, Maryland
| | - Joann Bodurtha
- McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University, Baltimore, Maryland
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17
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Hypercalcémie révélant une sarcoïdose chez un enfant. Arch Pediatr 2016; 23:508-13. [DOI: 10.1016/j.arcped.2016.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 10/26/2015] [Accepted: 02/17/2016] [Indexed: 11/18/2022]
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18
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Thomas JM, Bhandari J, Rytina E, Gass JK, Williams RM, Burrows NP. Subcutaneous Fat Necrosis of the Neonate with a Delayed Second Eruption. Pediatr Dermatol 2016; 33:e134-6. [PMID: 26821771 DOI: 10.1111/pde.12764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Subcutaneous fat necrosis (SCFN) of the neonate is a rare panniculitis of early life that occurs in association with gestational diabetes and preeclampsia, as well as perinatal asphyxia, hypothermia, and trauma. A characteristic feature of this condition is its self-limiting and monophasic nature. We report a highly unusual case of delayed SCFN in a male neonate involving an anatomically discrete eruption, reminiscent of erythema nodosum, occurring many weeks after his original eruption had resolved.
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Affiliation(s)
- Justyn M Thomas
- Addenbrooke's Hospital, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge, UK
| | - Jasjit Bhandari
- Addenbrooke's Hospital, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge, UK
| | - Ed Rytina
- Addenbrooke's Hospital, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge, UK
| | - Julia K Gass
- Addenbrooke's Hospital, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge, UK
| | - Rachel M Williams
- Addenbrooke's Hospital, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge, UK
| | - Nigel P Burrows
- Addenbrooke's Hospital, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge, UK
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19
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Subcutaneous Fat Necrosis of the Newborn: A Case Report of a Term Infant Presenting with Malaise and Fever at Age of 9 Weeks. Case Rep Pediatr 2015; 2015:638962. [PMID: 26635987 PMCID: PMC4617878 DOI: 10.1155/2015/638962] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Revised: 09/26/2015] [Accepted: 09/27/2015] [Indexed: 11/17/2022] Open
Abstract
Background. Subcutaneous fat necrosis (SFN) is a rare, temporary, self-limited pathology affecting adipose tissue of full-term or postmature neonates. It is a rare entity especially in Nigeria and usually occurs in the first weeks following a complicated delivery. Because it is not very common, diagnosis is easily missed. It may resolve spontaneously without sequelae but patients need to be followed up because of development of late complications especially hypercalcemia. We report a case of SFN of the newborn noted within one week of birth and highlight the need for proper prompt diagnosis and the need for follow-up to assess possible complications.
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20
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Samedi VM, Yusuf K, Yee W, Obaid H, Al Awad EH. Neonatal hypercalcemia secondary to subcutaneous fat necrosis successfully treated with pamidronate: a case series and literature review. AJP Rep 2014; 4:e93-6. [PMID: 25452891 PMCID: PMC4239139 DOI: 10.1055/s-0034-1395987] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Accepted: 10/01/2014] [Indexed: 11/08/2022] Open
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.
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Affiliation(s)
- Veronica Mugarab Samedi
- Section of Neonatology, Peter Lougheed Centre, Calgary, Alberta, Canada ; Section of Neonatology, University of Calgary, Calgary, Alberta, Canada
| | - Kamran Yusuf
- Section of Neonatology, University of Calgary, Calgary, Alberta, Canada
| | - Wendy Yee
- Section of Neonatology, University of Calgary, Calgary, Alberta, Canada
| | - Hala Obaid
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Essa Hamdan Al Awad
- Section of Neonatology, Peter Lougheed Centre, Calgary, Alberta, Canada ; Section of Neonatology, University of Calgary, Calgary, Alberta, Canada
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21
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Shumer DE, Thaker V, Taylor GA, Wassner AJ. Severe hypercalcaemia due to subcutaneous fat necrosis: presentation, management and complications. Arch Dis Child Fetal Neonatal Ed 2014; 99:F419-21. [PMID: 24907163 PMCID: PMC4134364 DOI: 10.1136/archdischild-2014-306069] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Subcutaneous fat necrosis (SCFN) is a rare form of panniculitis in infants that generally occurs following birth trauma, meconium aspiration, or therapeutic cooling. Severe hypercalcaemia occurs in a subset of patients, but data on its presentation, management and outcomes are limited. This report details the clinical course and complications of infants treated for severe hypercalcaemia (peak serum calcium ≥3.0 mmol/L) due to SCFN. DESIGN Chart review of all infants with SCFN seen at a single paediatric centre over a 13-year period. PATIENTS Seven infants with SCFN developed severe hypercalcaemia, with median peak serum calcium 4.1 mmol/L (range 3.3-5.1). RESULTS Severe hypercalcaemia occurred before 6 weeks of age, and was asymptomatic in 3/7 patients (43%). Most patients were treated with intravenous hydration, furosemide, glucocorticoids and low-calcium formula, which restored normocalcaemia in a median of 9 days (range 2-42). Fever developed during treatment in 4/7 infants (57%): two patients had bacterial infections and two had no infectious source identified. Nephrocalcinosis was present in 5/6 patients (83%) who were evaluated by renal ultrasound. Nephrocalcinosis failed to resolve in all cases over a median follow-up of 20 months (range 8-48), but no renal dysfunction was observed. Eosinophilia, which has not been reported previously in SCFN, was present in 6/7 patients (86%). CONCLUSIONS In this largest series to date of infants with severe hypercalcaemia due to SCFN, novel findings include the common occurrence of fever and a high incidence of persistent nephrocalcinosis without evidence of adverse renal outcomes.
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Affiliation(s)
- Daniel E. Shumer
- Boston Children’s Hospital, Division of Endocrinology, Boston, Massachusetts, USA
| | - Vidhu Thaker
- Boston Children’s Hospital, Division of Endocrinology, Boston, Massachusetts, USA
| | - George A. Taylor
- Boston Children’s Hospital, Department of Radiology, Boston, Massachusetts, USA
| | - Ari J. Wassner
- Boston Children’s Hospital, Division of Endocrinology, Boston, Massachusetts, USA
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22
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Moraitis AG, Hewison M, Collins M, Anaya C, Holick MF. Hypercalcemia associated with mineral oil-induced sclerosing paraffinomas. Endocr Pract 2013; 19:e50-6. [PMID: 23337133 DOI: 10.4158/ep12092.cr] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Granuloma-forming diseases such as sarcoidosis are associated with extrarenal synthesis of 1,25-dihydroxyvitamin D [1,25(OH)₂D]. We describe a case of extensive skin lesions associated with mineral oil injections in which we provide evidence for cutaneous granuloma synthesis of 1,25(OH)₂D in the pathogenesis of the patient's hypercalcemia. METHODS Analysis of expression of the 25(OH)D-1a-hydroxylase (1-a OHase [CYP27b1]) was carried out by immunohistochemical analysis of involved skin. RESULTS In involved skin, expression of CYP27b1 was found in the dermis, where it is not normally expressed. Successful management of hypercalcemia was achieved with glucocorticoids. CONCLUSIONS Hypercalcemia associated with mineral oil induced skin lesions is likely driven by unregulated expression of CYP27b1 by inflammatory monocytes and macrophages infiltrating the dermis.
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Affiliation(s)
- Andreas G Moraitis
- Eunice Shriver Kennedy National Institute of Child Health and Human Development, National Institutes of Health (NIH), Bethesda, Maryland, USA.
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23
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Abstract
Subcutaneous fat necrosis of infancy is a rare disorder of subcutaneous adipose tissue that is sometimes complicated by hypercalcemia. Complete resolution is common. From the pediatrician's point of view, the disease is a rare but important cause of inconsolable cry in a newborn.
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Affiliation(s)
- Arijit Coondoo
- Department of Dermatology, KPC, Medical College and Hospital, Kolkata, India
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24
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Akcay A, Akar M, Oncel MY, Kızılelma A, Erdeve O, Oguz SS, Uras N, Dılmen U. Hypercalcemia due to subcutaneous fat necrosis in a newborn after total body cooling. Pediatr Dermatol 2013; 30:120-3. [PMID: 22352980 DOI: 10.1111/j.1525-1470.2011.01716.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Subcutaneous fat necrosis is an inflammatory disorder of adipose tissue. Although patients need long-term follow-up to prevent hypercalcemia, the prognosis is generally favorable. We herein present a case of a newborn who developed subcutaneous fat necrosis-related hypercalcemia after hypothermia treatment for hypoxic ischemic encephalopathy. Widespread use of hypothermia treatment for hypoxic ischemic encephalopathy in the neonatal intensive care unit may increase the risk of developing subcutaneous fat necrosis and subsequently hypercalcemia. Great care should be taken to recognize skin findings early in newborns receiving hypothermia treatment, and those diagnosed with subcutaneous fat necrosis require close follow-up because they are at risk for developing hypercalcemia.
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Affiliation(s)
- Ahmet Akcay
- Zekai Tahir Burak Maternity Teaching Hospital, Ankara, Turkey
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25
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Chun RF, Adams JS, Hewison M. Immunomodulation by vitamin D: implications for TB. Expert Rev Clin Pharmacol 2012; 4:583-91. [PMID: 22046197 DOI: 10.1586/ecp.11.41] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
TB remains a major cause of mortality throughout the world. Low vitamin D status has been linked to increased risk of TB and other immune disorders. These observations suggest a role for vitamin D as a modulator of normal human immune function. This article will detail the cellular and molecular mechanisms by which vitamin D regulates the immune system and how vitamin D insufficiency may lead to immune dysregulation. The importance of vitamin D bioavailability as a mechanism for defining the immunomodulatory actions of vitamin D and its impact on TB will also be discussed. The overall aim will be to provide a fresh perspective on the potential benefits of vitamin D supplementation in the prevention and treatment of TB.
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Affiliation(s)
- Rene F Chun
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, 615 Charles E. Young Drive South, Los Angeles, CA 90095, USA
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26
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Filippi L, Catarzi S, Padrini L, Fiorini P, la Marca G, Guerrini R, Donzelli GP. Strategies for reducing the incidence of skin complications in newborns treated with whole-body hypothermia. J Matern Fetal Neonatal Med 2012; 25:2115-21. [PMID: 22524246 DOI: 10.3109/14767058.2012.683898] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To present the results of a strategy designed to reduce the incidence of skin complications in newborns with hypoxic-ischemic 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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Affiliation(s)
- Luca Filippi
- Neonatal Intensive Care Unit, Medical Surgical Feto-Neonatal Department, A. Meyer University Children's Hospital, Florence, Italy.
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27
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Subcutaneous fat necrosis as a complication of therapeutic hypothermia in a term neonate. Indian J Pediatr 2012; 79:664-6. [PMID: 21858549 DOI: 10.1007/s12098-011-0534-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2011] [Accepted: 07/14/2011] [Indexed: 10/17/2022]
Abstract
Subcutaneous fat necrosis of the newborn (SCFN) is a benign self-limited disorder commonly associated with hypothermia and perinatal asphyxia. SCFN secondary to therapeutic whole body hypothermia has rarely been reported. With increasing use of cooling for moderate to severe hypoxic ischemic encephalopathy (HIE), clinicians should recognize this potential complication.
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28
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Ichimiya H, Arakawa S, Sato T, Shimada T, Chiba M, Soma Y, Mizoguchi M, Tomonari K, Iwasaka H, Hatano Y, Okamoto O, Fujiwara S. Involvement of brown adipose tissue in subcutaneous fat necrosis of the newborn. Dermatology 2011; 223:207-10. [PMID: 21968020 DOI: 10.1159/000331810] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2011] [Accepted: 07/30/2011] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Subcutaneous fat necrosis (SCFN) of the newborn is a rare condition that manifests within days after birth. The interscapular region, axillae and shoulders are the most commonly affected sites, corresponding to anatomic sites of brown adipose tissue (BAT) in newborns. OBJECTIVE We postulated a specific involvement of BAT in SCFN and searched for brown adipocytes at affected sites. METHODS Biopsy specimens were immunostained with antibodies against uncoupling protein 1 (UCP-1) and examined by electron microscopy. We also examined BAT by (18)F-fluorodeoxyglucose ((18)F-FDG) positron emission tomography and computed tomography (PET-CT) scanning. RESULTS A few cells in biopsy specimens from two patients bound antibodies against UCP-1, and brown adipocytes were detected at several stages of degeneration. PET-CT scans revealed lower uptake of (18)F-FDG at major sites of SCFN. CONCLUSION SCFN and BAT can be found at the same sites, suggesting a pathophysiological connection.
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Affiliation(s)
- H Ichimiya
- Department of Dermatology, Oita Prefectural Hospital, Faculty of Medicine, Oita University, Idaigaoka 1-1, Hasama-machi, Yufu City, Japan
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Mitra S, Dove J, Somisetty SK. Subcutaneous fat necrosis in newborn-an unusual case and review of literature. Eur J Pediatr 2011; 170:1107-10. [PMID: 21318229 DOI: 10.1007/s00431-011-1405-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2010] [Accepted: 01/18/2011] [Indexed: 11/29/2022]
Abstract
UNLABELLED Subcutaneous fat necrosis (SCFN) of the newborn is an uncommon, self-limiting panniculitis mostly occurring within the first few weeks after birth. SCFN has been described mostly in term or post-term newborn infants in literature. We report a preterm infant developing extensive subcutaneous fat necrosis within the first week of life after significant perinatal hypoxic injury. The infant was conservatively managed for subcutaneous fat necrosis but developed hypercalcaemia and required prolonged medical treatment. Hypercalcaemia is a rare but serious complication of subcutaneous fat necrosis and needs prolonged follow-up. The etiopathogenesis of both subcutaneous fat necrosis in newborn and the resultant hypercalcaemia are poorly understood. CONCLUSION Significant subcutaneous fat necrosis can develop in both preterm and term infants, and preterm infants also develop significant complications including hypercalcaemia.
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Affiliation(s)
- Subhabrata Mitra
- Clinical Research Fellow in Neonatology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Trust, Cambridge, CB2 0QQ, UK.
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30
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Oliveira ACS, Selores M, Pereira O. Necrose adiposa do recém-nascido: a propósito de dois casos clínicos. An Bras Dermatol 2011; 86:S114-7. [DOI: 10.1590/s0365-05962011000700030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2011] [Accepted: 01/30/2011] [Indexed: 11/22/2022] Open
Abstract
A necrose adiposa subcutânea do recém-nascido é uma paniculite rara do período neonatal. Surge, geralmente, em recém-nascidos de termo ou pós-termo, nas primeiras 4 semanas de vida, e em associação com trauma obstétrico. Caracteriza-se pelo aparecimento de placas ou nódulos subcutâneos duros, localizados ao tronco, nádegas ou coxas. O seu curso é, geralmente, benigno e autolimitado, embora possa acompanhar-se de hipercalcemia, o que obriga a uma vigilância periódica até à resolução das lesões cutâneas. Os autores descrevem 2 casos de necrose adiposa subcutânea do recém-nascido, um num recémnascido de termo, outro num prematuro, ambos associados a partos traumáticos e a sofrimento fetal
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31
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Zifman E, Mouler M, Eliakim A, Nemet D, Pomeranz A. Subcutaneous fat necrosis and hypercalcemia following therapeutic hypothermia--a patient report and review of the literature. J Pediatr Endocrinol Metab 2010; 23:1185-8. [PMID: 21284334 DOI: 10.1515/jpem.2010.186] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Subcutaneous fat necrosis (SCFN) of the newborn is an uncommon dermatologic disorder characterized by firm, palpable subcutaneous nodules or plaques with or without erythema. Despite its benign course, SCFN may become complicated by extracutaneous manifestations. Hypercalcemia is considered a rare complication, but it is potentially fatal if unrecognized. During the last several years therapeutic hypothermia (TH) became an essential new therapeutic modality for severe neonatal asphyxia. We report a neonate who presented with SCFN and hypercalcemia following hypothermia therapy for hypoxic ischemic encephalopathy (HIE) and provide a review of the contemporary literature on the topic. We believe that this is important since the use of TH is rapidly increasing, and therefore, the possible side effects including SCFN and hypercalcemia may also become more prevalent. This prompts the need for awareness by treating physicians for this complication.
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Affiliation(s)
- Eyal Zifman
- Pediatric Department, Meir Medical Center, Kfar-Saba, Sackler School of Medicine, Tel-Aviv University, Israel
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