Background
Methods
Literature research
Definition of sub-groups
Results
Literature research
Clinical characteristics of subcutaneous fat necrosis (SCFN)
Diagnosis
Time of diagnosis
Subgroups | ||||||
---|---|---|---|---|---|---|
All patients (n = 320) | Normocalcaemia (n = 52) | Hypercalcaemia (n = 146) | Hypocalcaemia (n = 9) | No information about calcium level (n = 113) | ||
Age at diagnosis of SCFN [days after birth] | N | 297 | 42 | 136 | 8 | 108 |
mean ± SD | 11.3 ± 11.6 | 11.1 ± 9.1 | 11.8 ± 12.0 | 6.3 ± 5.8 | 11.4 ± 12.3 | |
Size of skin lesion (cm2) | N | 83 | 20 | 36 | 1 | 26 |
mean ± SD | 17.3 ± 38.1 | 19.0 ± 33.8 | 24.3 ± 50.3 | 3.8 ± 0 | 8.1 ± 9.8 | |
Symptoms at time of diagnosis | N | 285 | 22 | 194 | 6 | 63 |
Radial paresis | N (%) | 30 (10.5) | 1 (4.5) | 0 (0.0) | 0 (0.0) | 29 (46.0) |
Vomiting, diarrhoea | N (%) | 29 (10.2) | 1 (4.5) | 25 (12.9) | 0 (0.0) | 3 (4.8) |
Failure to thrive | N (%) | 28 (9.8) | 1 (4.5) | 27 (13.9) | 0 (0.0) | 0 (0.0) |
Fever | N (%) | 25 (8.8) | 3 (13.6) | 17 (8.7) | 0 (0.0) | 5 (7.9) |
Heart disease | N (%) | 21 (7.4) | 6 (27.3) | 13 (6.7) | 2 (33.3) | 0 (0.0) |
Weight loss | N (%) | 18 (6.3) | 1 (4.5) | 16 (8.2) | 0 (0.0) | 1 (1.6) |
Poor feeding (breast milk/formula) | N (%) | 18 (6.3) | 2 (9) | 15 (7.7) | 0 (0.0) | 1 (1.6) |
Increased excitability | N (%) | 17 (6.0) | 0 (0.0) | 16 (8.2) | 0 (0.0) | 1 (1.6) |
Muscular hypotonia | N (%) | 11 (3.9) | 0 (0.0) | 8 (4.1) | 1 (16.7) | 2 (3.2) |
Lethargy | N (%) | 11 (3.9) | 0 (0.0) | 8 (4.1) | 0 (0.0) | 3 (4.8) |
Dehydration | N (%) | 10 (3.5) | 0 (0.0) | 8 (4.1) | 0 (0.0) | 3 (4.8) |
Furthera | N (%) | 37 (23.5) | 6 (27.3) | 41 (21.1) | 3 (50.0) | 17 (27.0) |
Serum calcium concentration [mmol/l] | N | – | – | 111 | – | – |
Mean ± SD | – | – | 3.6 ± 0.6 | – | – | |
Ionised calcium [mmol/l] | N | – | – | 19 | – | – |
Mean ± SD | – | – | 1.8 ± 1.0 | – | – | |
Vitamin D concentration (25(oH)D3) [ng/ml] | N | 33 | – | – | – | – |
Mean ± SD | 23.9 ± 15.8 | – | – | – | – | |
1,25(OH)2D3 [pmol/l] | N | 39 | – | – | – | – |
Mean ± SD | 212.9 ± 135.3 | – | – | – | – | |
Parathormon concentration [pmol/l] | N | 28 | – | – | – | – |
Mean ± SD | 14.1 ± 38.5 | – | – | – | – | |
Serum triglycerid concentration [mg/dl] | N | 18 | 2 | 14 | 2 | – |
Mean ± SD | 346.3 ± 177.9 | 214 ± 75 | 383.3 ± 183.5 | 219.2 ± 12.7 | – | |
Time between diagnosis of SCFN and electrolyte disturbance | N | 122 | – | 114 | 8 | – |
Mean ± SD | 18.6 ± 32.2 | – | 19.3 ± 32.7 | 8.8 ± 24.0 | – | |
Calcifications in relation to localisation | N | 97 | 5 | 85 | 1 | 6 |
Kidney | N (%) | 46 (47.4) | 0 (0.0) | 45 (53.0) | 0 (0.0) | 1 (16.7) |
subcutanous | N (%) | 36 (37.1) | 5 (100) | 26 (30.6) | 1 (100) | 4 (66.7) |
Brain | N (%) | 4 (4.1) | 0 (0.0) | 4 (4.7) | 0 (0.0) | 0 (0.0) |
Myocard | N (%) | 3 (3.1) | 0 (0.0) | 2 (2.4) | 0 (0.0) | 1 (16.7) |
Liver | N (%) | 3 (3.1) | 0 (0.0) | 3 (3.5) | 0 (0.0) | 0 (0.0) |
Blood vessels | N (%) | 2 (2.1) | 0 (0.0) | 2 (2.4) | 0 (0.0) | 0 (0.0) |
Stomach | N (%) | 1 (1.0) | 0 (0.0) | 1 (1.2) | 0 (0.0) | 0 (0.0) |
Bronchia | N (%) | 1 (1.0) | 0 (0.0) | 1 (1.2) | 0 (0.0) | 0 (0.0) |
Metaphyses | N (%) | 1 (1.0) | 0 (0.0) | 1 (1.2) | 0 (0.0) | 0 (0.0) |
Symptoms and course of SCFN | N | 140 | 26 | 65 | 8 | 41 |
duration until healing [days] | Mean ± SD | 90.8 ± 65.1 | 90.8 ± 60.2 | 100.6 ± 78.3 | 79.5 ± 43.9 | 77.3 ± 41.8 |
Localisation
Size of necrosis
Pathological finding of lesion
Clinical characteristics of neonates with subcutaneous fat necrosis (SCFN)
Gender distribution
subgroups | ||||||
---|---|---|---|---|---|---|
All patients (n = 320) | Normocalcaemia (n = 52) | Hypercalcaemia (n = 146) | Hypocalcaemia (n = 9) | No information about calcium level (n = 113) | ||
Sex | N | 307 | 50 | 138 | 8 | 111 |
Male | N (%) | 149 (48.5) | 24 (48) | 65 (47.1) | 1 (12.5) | 59 (53.1) |
Female | N (%) | 158 (51.5) | 26 (52) | 73 (52.9) | 7 (87.5) | 52 (46.9) |
Birth weight | N | 218 | 35 | 91 | 4 | 88 |
Mean ± SD | 3606±759 | 3232±937 | 3873±650 | 2975±763 | 3638±560 | |
APGAR score ≤ 3 | N | 115 | 19 | 68 | 3 | 15 |
1 min | N (%) | 78 (61.4) | 12 (46.2) | 47 (68.1) | 3 (66) | 9 (59.3) |
Complications that occurred during or in the first days after birth | N | 522 | 78 | 284 | 17 | 146 |
Asphyxia | N (%) | 62 (11.9) | 8 (10.3) | 30 (10.6) | 4 (23.5) | 20 (13.7) |
Respiratory distress | N (%) | 49 (9.4) | 10 (12.8) | 26 (9.2) | 2 (11.8) | 11 (7.5) |
Meconium aspiration | N (%) | 48 (9.2) | 3 (3.8) | 35 (12.3) | 0 (0.0) | 10 (6.8) |
Meconium in amniotic fluid | N (%) | 41 (7.9) | 6 (7.7) | 18 (6.3) | 3 (17.6) | 14 (9.6) |
Hypoglycaemia | N (%) | 41 (7.9) | 4 (5.1) | 22 (7.7) | 1 (5.9) | 15 (10.3) |
Hypoxic-ischemic encephalopathy | N (%) | 35 (6.7) | 8 (10.3) | 21 (7.4) | 1 (5.9) | 5 (3.4) |
Cerebral seizures | N (%) | 27 (5.2) | 4 (5.1) | 18 (6.3) | 0 (0.0) | 5 (3.4) |
Sepsis or infection | N (%) | 22 (4.2) | 0 (0.0) | 11 (3.9) | 0 (0.0) | 11 (7.5) |
Hypoxaemia | N (%) | 20 (3.8) | 0 (0.0) | 10 (3.5) | 0 (0.0) | 8 (5.5) |
Peripheral cyanosis | N (%) | 20 (3.8) | 5 (6.4) | 7 (2.5) | 0 (0.0) | 8 (5.5) |
Tachypnea | N (%) | 14 (2.7) | 2 (2.6) | 5 (1.8) | 2 (11.8) | 5 (3.4) |
Hypotension | N (%) | 14 (2.7) | 2 (2.6) | 9 (3.2) | 1 (5.9) | 2 (1.7) |
Anaemia/thrombocytopenia | N (%) | 14 (2.7) | 2 (2.6) | 5 (1.8) | 0 (0.0) | 8 (5.8) |
Acute renal failure | N (%) | 10 (2.0) | 2 (2.6) | 7 (2.5) | 0 (0.0) | 1 (0.7) |
Foetal disstress | N (%) | 10 (2.0) | 3 (3.8) | 7 (2.5) | 0 (0.0) | 0 (0.0) |
Bradycardia | N (%) | 10 (2.0) | 1 (1.1) | 6 (2.1) | 0 (0.0) | 3 (2.1) |
Dystocia | N (%) | 5 (1.0) | 3 (3.8) | 0 (0.0) | 1 (5.9) | 1 (0.7) |
Further | N (%) | 80 (15.3) | 13 (16.7) | 48 (16.9) | 2 (11.8) | 17 (11.6) |
Treatment of birth complications | ||||||
Drugs | N (%) | 78 (30.5) | 14 (26.4) | 37 (30.3) | 3 (37.5) | 24 (32.9) |
Intubation and ventilation | N (%) | 75 (29.3) | 15 (28.3) | 34 (27.9) | 2 (25.0) | 24 (32.9) |
Therapeutic hypothermia treatment | N (%) | 51 (19.9) | 11 (20.8) | 27 (22.1) | 1 (12.5) | 12 (16.4) |
Reanimation | N (%) | 46 (18.0) | 11 (20.8) | 23 (18.9) | 1 (12.5) | 11 (15.1) |
Coma | N (%) | 3 (1.2) | 0 (0.0) | 1 (0.8) | 0 (0.0) | 2 (2.7) |
Phototherapy | N (%) | 2 (0.8) | 2 (3.8) | 0 (0.0) | 0 (0.0) | 0 (0.0) |
Reduction of the intracranial pressure | N (%) | 1 (0.4) | 0 (0.0) | 0 (0.0) | 1 (12.5) | 0 (0.0) |
Birth weight
APGAR score
Birth complications
Treatment of birth complications
Amniotic infection/early onset newborn sepsis
Clinical symptoms
Serum vitamin D concentration
Serum triglycerides
Calcifications in different tissues
Duration until resolution of symptoms
Long-term consequences
Treatment of SCFN-associated complications in neonates
Treatment of birth complications
Treatment of hypercalcaemia
Maternal risk factors related to SCFN in newborns
Maternal and pregnancy parameters
Subgroups | ||||||
---|---|---|---|---|---|---|
All patients (n = 320) | Normocalcaemia (n = 52) | Hypercalcaemia (n = 146) | Hypocalcaemia (n = 9) | No information about calcium level (n = 113) | ||
Maternal age at delivery (years) | N | 73 | 14 | 28 | 1 | 28 |
Mean ± SD | 30.8 ± 6.7 | 31.4 ± 5.8 | 30.3 ± 5.4 | 30 | 30.7 ± 8.05 | |
Gestational diabetes | N | 24 | 3 | 10 | 1 | 10 |
% | 23.3 | 15.8 | 33.3 | 100 | 32.3 | |
Hypertension/preeclampsia | N | 19 | 5 | 4 | 0 | 9 |
% | 18.4 | 26.3 | 13.3 | 0 | 29.0 | |
Diabetes mellitus type 1 | N | 6 | 1 | 3 | 0 | 3 |
% | 5.8 | 5.3 | 10 | 0 | 9.7 | |
Maternal smoking | N | 6 | 2 | 2 | 0 | 3 |
% | 5.8 | 10.5 | 6.6 | 0 | 9.7 | |
Pregnancy duration (weeks) | N | 117 | 22 | 57 | 2 | 36 |
Mean ± SD | 39.3 ± 2.6 | 38.3 ± 3.7 | 39.7 ± 2.1 | 41 ± 0 | 38.3 ± 3 | |
Mode of delivery | N | 320 | 52 | 146 | 9 | 113 |
Vaginal | N (%) | 120 (37.5) | 24 (46.2) | 36 (24.7) | 2 (22.2) | 58 (51.3) |
Sectio | N (%) | 154 (48.1) | 23 (44.2) | 83 (56.8) | 7 (77.8) | 41 (36.3) |
No information available | N (%) | 46 (14.4) | 5 (9.6) | 27 (18.5) | 0 (0.0) | 14 (12.4) |