Subcutaneous Fat Necrosis After Moderate Therapeutic Hypothermia in Neonates

Dear Editor, We read with great interest the recent paper by Strohm et al (1) in which the authors reported that a full-term baby who developed subcutaneous fat necrosis-related hypercalcemia following hypothermia treatment for hypoxic-ischemic encephalopathy (HIE). Therapeutic moderate hypothermia in newborns with HIE is rapidly becoming standart clinical practice. As being the largest NICU in Turkey with more than 4000 admissions per year, we use adjusted whole-body hypothermia treatment for HIE. We report here 3 cases of subcutaneous fat necrosis among 45 cases (6%) registered to our cohort of newborns treated with moderate whole-body hypothermia. Although all infants suffered from HIE and received whole-body hypothermia, severe hypercalcemia was identified in only one patient. In all cases skin lesions appeared just after the completion of the hypothermia treatment. Our data suggest that moderated hypothermia is an actual risk factor for subcutaneous fat necrosis in addition to asphyxia itself because we experienced all cases just after the completion of the treatment like Fumagalli et al (2). Although Strohm et al (1) reported only 12 subcutaneous fat necrosis among 1239 moderately hypothermia treatment cases, recent reported reports (3,4) and our cohort demonstrates that physicians should be aware of this painful condition and related complications. References 1. Strohm B, Hobson A, Brocklehurst P, Edwards AD, Azzopardi D. Subcutaneous Fat Necrosis After Moderate Therapetic Hypothermia in Neonates. Pediatrics 2011; 128: e1-3. 2. Fumagelli M, Ramenghi LA, Pisoni S, Borzani I, Mosca F. Arch Dis Child Fetal Neonatal Ed. September 2011;96:F377. doi:10.1136/adc.2010.207886. 3. Edwards AD, Brocklehurst P, Gunn AJ, et al. Neurological outcomes at 18 months of age after moderate hypothermia for perinatal hypoxic ischeaemic encephalopathy: synthesis and metaanalysis of trial data. BMJ 2010;340:c363. 4. Azzopardi D, Strohm B, Edwards AD, et al. Treatment of asphyxiated newborns with moderate hypothermia in routine clinical practice: how cooling is maneged in the UK outside a clinical trial. Arch Dis Child Fetal Neonatal Ed. 2009;94:F260-F264.

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