Subcutaneous Fat Necrosis of the Newborn Clinical Presentation
- Author: Sungat K Grewal; Chief Editor: William D James, MD more...
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. Most have had some antecedent obstetric trauma, meconium aspiration, asphyxia, hypothermia, or peripheral hypoxemia. Congenital ulceration has been reported.
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. As the lesions progress, they may become fluctuant and spontaneously drain necrotic fat.
See the images below.
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. One infant developed subcutaneous fat necrosis of the newborn after ice-bag placement for the treatment of supraventricular tachycardia 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, placenta previa, umbilical cord prolapse, anoxia, seizures, preeclampsia, maternal cocaine abuse, gestational diabetes, maternal use of calcium antagonists during pregnancy, familial dyslipidemia, and a family history of thrombophilia. Some evidence implicates a maternal hypercoagulable state such as protein C deficiency and antiphospholipid syndrome. 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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