Sclerema Neonatorum Treatment & Management
- Author: India Mayo Hill, MD; Chief Editor: Dirk M Elston, MD more...
Recognition and the prompt institution of therapy specific for the underlying disease are mandatory. Careful monitoring, correction of electrolyte abnormalities, respiratory support, correction of hypovolemia, and control of hypothermia are important in sclerema neonatorum patients.
Some authors advocate the prompt institution of prophylactic broad-spectrum antibiotic therapy for possible associated sepsis.
The value of systemic steroids is controversial. No controlled studies have demonstrated improved survival with the use of systemic steroids in sclerema neonatorum, although they are often used and have been observed to limit the extent and development of new lesions.[2, 8]
Several reports document the beneficial effect of exchange transfusions on survival.[1, 3, 4, 16] A randomized controlled trial demonstrated a 50% survival rate in septic neonates with sclerema neonatorum who were treated with exchange transfusion used early in the course of the disease, compared with 5% who were not. Exchange transfusion may enhance humoral and cellular immunity in these immunologically immature neonates, and may improve peripheral and pulmonary circulation, thereby also improving oxygen exchange.[2, 16]
One case report describes the use of intravenous immunoglobulin in a neonate. There was transient improvement in the skin disease, but thoracic constriction from sclerema neonatorum ultimately led to the child's death.
Infants with sclerema neonatorum are best cared for in a neonatal intensive care unit by an intensivist.
Depending on the underlying illness (eg, sepsis), consultation to the appropriate specialists should be made.
Unless the underlying disease is identified and treated, the course of sclerema neonatorum is one of rapid deterioration in the general health of the infant and, ultimately, death.
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