Department of Pediatrics, Division of Neonatology, Children's Mercy Hospital, University of Kansas, 3600 E Harry St., Wichita, 67218 KS, USA.
Pediatric Endocrinology, The State University of New York, University at Buffalo, Buffalo, NY, USA.
J Perinat Med. 2019 Nov 26;47(9):986-990. doi: 10.1515/jpm-2019-0172.
Objective To describe the clinical characteristics and risk factors in infants with subcutaneous fat necrosis (SFN) following therapeutic hypothermia for hypoxic-ischemic encephalopathy (HIE). Methods A case-control study was performed by a retrospective chart review of infants with moderate or severe HIE admitted to a level IV regional perinatal center and who underwent whole-body cooling. Results A total of 14 (8.1%) of 171 infants with moderate or severe HIE who underwent whole-body cooling developed SFN during hospitalization. There were more females [71% (10/14)] and large-for-gestational age (LGA) infants [28% (4/14)] in the SFN group vs. 36% females (57/157) and 8% LGA infants (13/157) in the group without SFN (P-values of 0.009 and 0.015, respectively). The mean lowest platelet count was lower 108 ± 55 109/L vs. 146 ± 62 109/L and the mean highest calcium level was higher 11.3 ± 2.5 vs. 10.6 ± 0.8 mg/dL in infants with SFN vs. infants without SFN, respectively (P-values of 0.0078 and 0.006, respectively). Distribution of skin lesions followed distinctive patterns representing the areas with direct contact with the cooling blanket. One infant developed severe, life-threatening hypercalcemia that required aggressive management, including diuretics, corticosteroids and bisphosphonates. Conclusion Although SFN is a rare complication of therapeutic hypothermia, it can be a life-threatening condition if complicated by severe hypercalcemia. Infants who undergo therapeutic hypothermia for HIE need regular skin examinations to evaluate for SFN. If SFN is identified, monitoring of serum calcium levels to prevent life-threatening hypercalcemia is recommended.
目的 描述接受亚低温治疗的缺氧缺血性脑病（HIE）婴儿中，发生皮下脂肪坏死（SFN）的临床特征和危险因素。
方法 通过对在四级区域围产期中心接受全身冷却治疗的中重度 HIE 婴儿的回顾性病历审查，进行病例对照研究。
结果 在 171 名接受全身冷却治疗的中重度 HIE 婴儿中，共有 14 名（8.1%）在住院期间发生 SFN。SFN 组中女性（71%[10/14]）和大于胎龄儿（LGA）婴儿（28%[4/14]）的比例高于无 SFN 组（36%女性[57/157]和 8%LGA 婴儿[13/157]）（P 值分别为 0.009 和 0.015）。SFN 组婴儿的最低血小板计数为 108±55 109/L，而无 SFN 组婴儿的最低血小板计数为 146±62 109/L，SFN 组婴儿的最高钙水平为 11.3±2.5 mg/dL，而无 SFN 组婴儿的最高钙水平为 10.6±0.8 mg/dL（P 值分别为 0.0078 和 0.006）。皮肤损伤的分布呈现出与冷却毯直接接触的区域的独特模式。有 1 名婴儿发生严重的、危及生命的高钙血症，需要积极治疗，包括利尿剂、皮质类固醇和双膦酸盐。
结论 尽管 SFN 是亚低温治疗的罕见并发症，但如果并发严重高钙血症，可能会危及生命。接受 HIE 亚低温治疗的婴儿需要定期进行皮肤检查，以评估是否发生 SFN。如果发现 SFN，建议监测血清钙水平以预防危及生命的高钙血症。
