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Subcutaneous Fat Necrosis of the Newborn Clinical Presentation

  • Author: Sungat K Grewal; Chief Editor: William D James, MD  more...
 
Updated: Apr 04, 2016
 

History

Newborns who develop subcutaneous fat necrosis of the newborn (SFNN) are usually healthy and full-term at delivery, although reports have described children with subcutaneous fat necrosis of the newborn who were born with macrosomia or postterm with normal size.[10] Most have had some antecedent obstetric trauma, meconium aspiration, asphyxia, hypothermia, or peripheral hypoxemia. Congenital ulceration has been reported.

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Physical

Infants with subcutaneous fat necrosis of the newborn (SFNN) usually appear well. The condition begins as an area of edema and progresses to variably circumscribed nodules and plaques that have a deep, indurated feel, implying a panniculitis. The overlying skin may be flesh-colored, red, or purple and may look taut and shiny. The lesions are not warm and are commonly seen on the trunk, arms, buttocks, thighs, or cheeks. Pain may occur, with a frequency as high as 25% in one series.[10] As the lesions progress, they may become fluctuant and spontaneously drain necrotic fat.

See the images below.

Ill-defined erythema overlying an indurated plaqueIll-defined erythema overlying an indurated plaque of a newborn.
Bruiselike indurated plaque of subcutaneous fat neBruiselike indurated plaque of subcutaneous fat necrosis of the newborn on the lower back of a newborn.
Ill-defined erythema and induration of subcutaneouIll-defined erythema and induration of subcutaneous fat necrosis of the newborn on the posterior calf of a newborn.
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Causes

The cause of subcutaneous fat necrosis of the newborn (SFNN) is not known. Hypothermia is a common antecedent. The brown fat of neonates has a greater ratio of saturated palmitic acid to unsaturated oleic acid. Palmitic acid has a higher melting point than oleic acid, making it more susceptible to solidification and crystallization in response to lowered temperature. Many cases of subcutaneous fat necrosis of the newborn have been reported in newborns who sustained perinatal hypoxic-ischemic injury and were treated by hypothermia to prevent encephalopathy and serious brain injury.[11, 12, 13, 14] Cases of subcutaneous fat necrosis of the newborn have been reported after both whole-body cooling[15, 16, 17]  and selective head-cooling.[18] One infant developed subcutaneous fat necrosis of the newborn after ice-bag placement for the treatment of supraventricular tachycardia[19] and  another after hypothermic cardiac surgery.[1, 20]

Other neonatal stresses that have been associated with subcutaneous fat necrosis of the newborn include cesarean delivery,[1, 4, 21, 22] Rh factor incompatibility, meconium aspiration,[22] placenta previa, umbilical cord prolapse, anoxia, seizures,[22] preeclampsia, maternal cocaine abuse,[23] gestational diabetes,[10] maternal use of calcium antagonists during pregnancy,[24] familial dyslipidemia, and a family history of thrombophilia.[10] Some evidence implicates a maternal hypercoagulable state such as protein C deficiency and antiphospholipid syndrome.[10] Local pressure trauma during delivery from forceps, from prolonged labor, and from being large for gestational age (macrosomia) may play a role.[21, 22]

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Contributor Information and Disclosures
Author

Sungat K Grewal The Commonwealth Medical College

Disclosure: Nothing to disclose.

Coauthor(s)

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Specialty Editor Board

David F Butler, MD Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

David F Butler, MD is a member of the following medical societies: American Medical Association, Alpha Omega Alpha, Association of Military Dermatologists, American Academy of Dermatology, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Phi Beta Kappa

Disclosure: Nothing to disclose.

Edward F Chan, MD Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania School of Medicine

Edward F Chan, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Daniel Mark Siegel, MD, MS Clinical Professor of Dermatology, Department of Dermatology, State University of New York Downstate Medical Center

Daniel Mark Siegel, MD, MS is a member of the following medical societies: American Academy of Dermatology, American College of Mohs Surgery, American Association for Physician Leadership, American Society for Dermatologic Surgery, American Society for MOHS Surgery, International Society for Dermatologic Surgery

Disclosure: Nothing to disclose.

Acknowledgements

Howard Pride, MD Associate Physician, Departments of Pediatrics and Dermatology, Geisinger Medical Center

Howard Pride is a member of the following medical societies: American Academy of Dermatology and Society for Pediatric Dermatology

Disclosure: Nothing to disclose.

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Ill-defined erythema overlying an indurated plaque of a newborn.
Bruiselike indurated plaque of subcutaneous fat necrosis of the newborn on the lower back of a newborn.
Ill-defined erythema and induration of subcutaneous fat necrosis of the newborn on the posterior calf of a newborn.
Histological slides of early and later stages of subcutaneous fat necrosis of the newborn after fine-needle aspiration biopsy. Courtesy of Elsevier (Elston DM, Ferrringer T, Ko CJ, et al. Panniculitis. In: Dermatopathology. 2nd ed. Elsevier Limited; 2014:249-56).
 
 
 
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