Subcutaneous Fat Necrosis of the Newborn Treatment & Management

Updated: May 15, 2018
  • Author: Sungat K Grewal; Chief Editor: William D James, MD  more...
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Treatment

Medical Care

Subcutaneous fat necrosis of the newborn (SFNN) is usually a self-limited process that does not require treatment. Interventions have focused on the prevention of subcutaneous fat necrosis of the newborn in the setting of hypothermia, the treatment of hypercalcemia, and pain management.

To reduce the likelihood of developing subcutaneous fat necrosis of the newborn in infants with hypoxic ischemic encephalopathy who were treated with moderate whole-body hypothermia, the following steps have been suggested [23] :

  • Periodic mobilization of infants

  • Use of a gentler cooling blanket that induces hypothermia gradually without abrupt temperature changes

Such an approach was associated with a lower incidence of subcutaneous fat necrosis of the newborn, lower C-reactive protein levels, lower serum calcium, and a higher number of platelets. [23]

Hypercalcemia should be treated aggressively with fluid loading and calcium-wasting diuretics such as furosemide. Infants should be on a low-calcium, low-vitamin D diet. Prednisone may be used if these measures fail; it interferes with the conversion of vitamin D to its active form in the subcutaneous fat necrosis of the newborn granulomas. [1, 35] Bisphosphonates, which reduce bone resorption, have also been used to treat hypercalcemia. [1, 37, 38, 39, 40] Administration of pamidronate for 3 consecutive days (0.25-, 0.25-, and 0.50-mg/kg/dose, respectively) has successfully restored normocalcemia. [41] Shumer reported that the combination of intravenous hydration, furosemide, glucocorticoids, and low-calcium diets restored normocalcemia in 9 days. [25]

For pain management in infants with subcutaneous fat necrosis of the newborn, dexmedetomidine is a good choice because of its minimal adverse effects on respiratory and gastrointestinal function. [42] Alternatively, morphine (1-2 mg 4 times per day) and prednisone (1 mg/kg per day) may act synergistically to manage pain.

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Surgical Care

Fluctuant areas of fat necrosis may require needle aspiration or surgical incision and drainage, [12] but this is seldom needed.

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Consultations

Consultations include a dermatologist or pediatric dermatologist. A plastic surgeon or pediatric surgeon may be needed if aggressive debridement is warranted.

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Diet

A diet low in calcium and vitamin D is recommended if hypercalcemia is a complicating feature.

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Long-Term Monitoring

Because serum calcium may be elevated for several months after the resolution of subcutaneous fat necrosis of the newborn (SFNN), calcium levels should be checked periodically for at least 4 months. [1]

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