Total body cooling: skin and
Subcutaneous fat necrosis (SFN) is a rare, self-limiting panniculitis
mostly reported in infancy and childhood. Newborns
and infants have a greater saturated to unsaturated fats ratio
in their subcutaneous fat compared with older children and
adults, causing an increased tendency to crystallise with cold
A full-term baby suffering hypoxic ischaemic encephalopathy
(HIE) and treated with total body hypothermia is reported.
SFN was fi rst noted on physical examination at 35 h of life,
presenting with a very painful erythema on the upper back
area and evolving into fi rm erythematous nodules within a
few days (fi gure 1). A spontaneous skin recovery was observed
in the following weeks.
Hypercalcaemia is the most commonly recognised metabolic
complication of SFN.1 2 During the hospital stay calcium
plasma levels were normal. Despite weekly blood analysis after
discharge, the baby was evaluated in the emergency paediatric
department at 6 weeks of age with vomit and weight loss.
Severe hypercalcaemia (17 mg/dl) was observed. Abdominal
ultrasound scan showed hyperechoic foci involving all pyramids
in both kidneys, with normal appearance of the cortex,
consistent with nephrocalcinosis (fi gure 2).
Total body cooling has recently become a widely available
therapy for HIE3 4 but it is likely to increase the risk of SFN.5
Thus, neonatologists should be aware of these potentially
Monica Fumagalli,1 Luca A Ramenghi,1 Silvia Pisoni,1
Irene Borzani,2 Fabio Mosca1
1NICU, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Università degli
Studi di Milano, Milan, Italy
2Institute of Pediatrics-Pediatric Radiology Unit, Fondazione IRCCS Ca’ Granda
Ospedale Maggiore Policlinico, Milan, Italy
Correspondence to Dr Monica Fumagalli, NICU, Fondazione IRCCS Ca’ Granda
Ospedale Maggiore Policlinico, Università degli Studi di Milano, Via Commenda 12,
20122 Milan, Italy; firstname.lastname@example.org
Competing interests None.
Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.
Accepted 12 March 2011
Published Online First 16 May 2011
Arch Dis Child Fetal Neonatal Ed 2011;96:F377. doi:10.1136/adc.2010.207886