Cold panniculitis is a distinctive form of
panniculitis provoked directly by cold exposure to which infants
are more susceptible than adults.
The fat of the newborn appears to be more highly
saturated than that of older children and adults where it
solidifies at a higher temperature.
Cold panniculitis in infancy has almost always
follow exposure of the cheeks to extremely cold weather.
The lesions appear as indurated, warm, red,
subcutaneous plaques and nodules that manifest within hours or days
after exposure to cold. The most common sites involved are the cheeks
in infants, though they may be seen elsewhere in older children and
The induration resolves over a period of a week
or so, often leaving some residual postinflammatory
No treatment is required, though it is clearly
advisable for the child to avoid further cold exposure.
NEONATAL COLD INJURY
Neonatal cold injury is a disorder, which is due
to exposure of neonates to cold. The clinical manifestations are
hypothermia associated with lethargy and generalized pitting edema
of the skin simulating sclerema neonatorum.
Exposure to cold.
Intrauterine growth retardation, which results in
a relatively thin panniculus. Tight wrappings, which would restrict
Home delivery and traditional behavior of bathing
babies immediately after birth with cold water.
The infant is usually a full-term neonate, born
at home, but small for gestational age. In the great majority of
cases, presentation is within the first 4 days of life and usually
during the first 24 hours which has a high mortality rate. The infant
may show different general manifestations such as immobility,
drowsiness, poor feeding, vomiting, oliguria, and gastro-intestinal
bleeding with vomiting of altered blood or melena.
The most striking features are intense erythema,
cyanosis or petechiae of the face and extremities. Firm pitting
edema beginning at the extremities and spreading centrally which
becomes later progressive and more indurated.
The skin feels
cold and the baby is usually
Sclerema neonatorum .The generally healthy state
of the infant before the onset of the cutaneous induration and the
pitting nature may help in the differential diagnosis.
History of cold exposure.
Low rectal temperature.
SUBCUTANEOUS FAT NECROSIS OF THE NEW BORN
Subcutaneous fat necrosis of the newborn is an
uncommon and transient disorder of neonates in which focal areas of
fat necrosis cause nodular skin lesions.
This nodular necrosis of subcutaneous fat may
occasionally be associated with hypercalcaemia.
Subcutaneous fat necrosis generally occurs in
full-term or post-term infants of normal birth weight, during the
first 6 weeks of life.
Different predisposing factors play an important
role in the etiology of subcutaneous fat necrosis of the newborn.
These include the following:
Protease inhibitor deficiency.
Disorder of brown fat.
Transient thrombocytopenia has been reported
during the period of initial development of the lesions, possibly
due to the sequestration of platelets.
Infants who develop subcutaneous fat necrosis are
generally full-term or post-term neonates of normal weight. In most
cases, the child‘s health is not
impaired, and within a few months the nodules disappear.
Skin lesions may be single or multiple, rounded
or oval, and pea-sized or many centimeters in diameter and
symmetrically distributed. They are initially discrete but may fuse
to form large plaques. The overlying skin is often red or
Nodular thickening of the subcutaneous tissues is
usually first detected between the second and 21st day of life. The
nodules tend to be multiple and show a predilection for buttocks, thighs,
shoulders, back, cheeks and arms. The nodules feel rubbery or hard
and are not attached to the deeper structures. New nodules may
continue to develop for a week or more.
Where calcium deposition is marked the lesions
may take rather longer to resolve. Usually no trace of the nodules
remains but there may be slight atrophy.
Rarely, the nodules may ulcerate, discharge their
fatty contents and leave scars.
The condition has occasionally been fatal,
particularly when visceral fat has been involved.
Neonates delivered by forceps may develop
subcutaneous nodules at the sites where the forceps were applied,
presumably as a result of traumatic fat necrosis.
All infants who have subcutaneous fat necrosis
should have their serum calcium measured on presentation and a few
If hypercalcaemia is present, its cause requires
thorough investigation to exclude disorders such as primary
hyperparathyroidism and vitamin D intoxication.
None is required.
Hypercalcaemia will require treatment by:
Administration of fursemide.
Restriction of dietary calcium and vitamin D.
Oral corticosteroids may be required in some
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