How common is subcutaneous fat necrosis in newborn with hypercalcemia in your practice and how do you manage it

Hi @Mohan , my experience is a bit limited, we do see fat necrosis from time to time and related elevation of s-calcium too, but asymptomatic. As far as I know, we have not needed to treat anyone, but if so, we would go for "standard management".

However, it happens we follow S-Ca during the first weeks after NICU discharge, just in case, but also those infants have normalised their levels with time.

I ping @Gustaf Lernfelt @Vicky Payne @ali @Mariana Oliveira - whats your "large level-3" experience?

I found this case series from Boston Children's Hospital: Shumer et al. (2014). Severe hypercalcaemia due to subcutaneous fat necrosis: presentation, management and complications. Archives of Disease in Childhood. Fetal and Neonatal Edition, 99(5), F419–F421, https://pmc.ncbi.nlm.nih.gov/articles/PMC4134364/

It's a chart review of 7 infants over 13-year period, so quite rare even for a large center. They report the use of iv hydration, furosemide, glucocorticoids and low-calcium formula for most patients. One patient was treated with calcitonin, and another with pamidronate after conventional therapy failed (reaching normocalcemia within 12 hours from pamidronate).

They also mention complications: fever, eosinophilia and persistent nephrocalcinosis (though without renal dysfunction over follow-up period).

Does it align with your experiences?

I rarely see this in my own unit, but I came across a case during my rotation at the Level 4 NICU, linked to a traumatic birth. One of our most experienced consultants noted that while it used to be more common, better nursing care during hypothermia treatment has made it a rare occurrence today. We diagnose it clinically and monitor ionized calcium levels every two weeks. If severe hypercalcemia, we restrict vitamine-D and start treatment with prednisone, not sure about dosing though.

On 2/11/2026 at 7:57 PM, Mohan said:

How common is subcutaneous fat necrosis in newborn with hypercalcemia in your practice and how do you manage it

Thankfully it is not very common. I have seen it rarely in neonates with hypoxic ischemic encephalopathy. Treatment of hypercalcemia consists primarily of hydration and diuresis and prednisone. In recalcitrant hypercalcemia addition of bisphosphonates might be needed. Below are pertinent references:

1. Subcutaneous Fat Necrosis Associated With Hypercalcemia in Neonates With Neonatal Encephalopathy Treated With Therapeutic Hypothermia. Seminars in Fetal & Neonatal Medicine. 2021. Rodd C, Schwieger-Briel A, Hagmann C.

2. Subcutaneous Fat Necrosis of the Newborn: A Retrospective Study of 32 Infants and Care Algorithm. Pediatric Dermatology. 2022. Siegel LH, Fraile Alonso C, Tuazon CFR, et al.

3. Hypercalcemia: A Review.The Journal of the American Medical Association. 2022. Walker MD, Shane E.

4. Severe Hypercalcaemia Due to Subcutaneous Fat Necrosis: Presentation, Management and Complications. Archives of Disease in Childhood. Fetal and Neonatal Edition. 2014. Shumer DE, Thaker V, Taylor GA, Wassner AJ.

5. Effectiveness of Pamidronate in Severe Neonatal Hypercalcemia Caused by Subcutaneous Fat Necrosis: A Case Report. European Journal of Pediatrics. 2009. Lombardi G, Cabano R, Bollani L, Del Forno C, Stronati M.

6. Oral Clodronate Therapy for Hypercalcemia Related to Extensive Subcutaneous Fat Necrosis in a Newborn. Journal of the Formosan Medical Association = Taiwan Yi Zhi. 2003. Hung SH, Tsai WY, Tsao PN, Chou HC, Hsieh WS.

7. Use of Zoledronic Acid in a Neonate With Subcutaneous Fat Necrosis Complicated With Severe, Refractory Hypercalcemia. American Journal of Perinatology. 2019. Militello MA, Re MP, Vitaliti G, et al.

8. Etidronate Therapy for Hypercalcemia in Subcutaneous Fat Necrosis of the Newborn. The Journal of Pediatrics. 1999. Rice AM, Rivkees SA.

9. Treatment With Bisphosphonates in Severe Hypercalcemia Due to Subcutaneous Fat Necrosis in an Infant With Hypoxic-Ischemic Encephalopathy. Journal of Perinatology : Official Journal of the California Perinatal Association. 2014. Pérez Martínez E, Camprubí Camprubí M, Ramos Cebrián M, et al.

Thanks to all for your responses. After conventional treatment with hydration ,Furosemide and steroids failed to completely reverse severe hypercalcemia I had to use Zoledronic Acid Injection as Pamidronate was not available. Serum ionized Calcium normalized to upper end of normal and the baby is on follow up