Sclerema Neonatorum Workup

Updated: Jun 25, 2018
  • Author: India Mayo Hill, MD; Chief Editor: Dirk M Elston, MD  more...
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Workup

Laboratory Studies

Laboratory abnormalities associated with sclerema neonatorum correlate with the underlying disease process. Hypoglycemia, metabolic acidosis, respiratory alkalosis, hyperkalemia, hypocalcemia, and elevated blood urea are common, albeit nonspecific, findings. A complete sepsis workup should be initiated in all infants with sclerema neonatorum.

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Histologic Findings

Despite the striking clinical presentation, histologic findings of sclerema neonatorum are subtle. The subcutaneous fat may appear normal or may have only sparse inflammation, which, when present, consists of lymphocytes, histiocytes, and multinucleated giant cells. This is thought to reflect the poor immunologic response of the infant. [15] The most consistent findings are edema, a thickening of the subcutaneous fibrous septa, and a radial array of fine, needlelike clefts in the fat cells, representing former sites of fat crystals. The lack of a granulomatous inflammation and the absence of fat necrosis help distinguish sclerema neonatorum from subcutaneous fat necrosis of the newborn (SCFN). [15, 16, 17] Radially arranged needlelike clefts are common to both sclerema neonatorum and SCFN.

See the image below.

Needle-shaped crystals are arranged radially in ad Needle-shaped crystals are arranged radially in adipocytes. Courtesy of DermNet New Zealand (https://www.dermnetnz.org/assets/Uploads/pathology/e/sclerema-neonatorum-fig-2.jpg).
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