Brown fat necrosis with calcifications in the newborn: Risk factors, radiographic findings, and clinical course

Abstract

Objective: To describe the radiographic appearance of subclinical calcified brown fat necrosis and the associated clinical and laboratory findings. Materials and Methods: Picture Archiving and Communications Sytem (PACS) was searched using keywords “soft tissue calcification” and “chest.” The clinical record was searched for prior cardiac surgery, bypass, Extracorporeal Membrane Oxygentation (ECMO) and prostaglandin use. Age when calcifications were first detected, location, resolution, and associated laboratory abnormalities were recorded. Results: Nine patients were identified. None had skin lesions. All patients had congenital heart disease and had experienced cardiac/respiratory arrest and/or severe hypotension 1–6 weeks before soft tissue calcifications occurred. Calcifications resolved by 9 weeks to 5 months in 3 patients. The remaining were either deceased or lacked follow-up imaging. Renal ultrasound was performed in all but 1 patient. Nephrocalcinosis was only seen in 1 patient. Conclusion: Brown fat necrosis is subclinical, diagnosed on plain film, and likely self-limited. It occurs in term and preterm infants who have undergone significant systemic stress and carries a poor prognosis.

Keywords

Neonate - neonatal imaging - subcutaneous fat necrosis

Publikationsverlauf

Artikel online veröffentlicht:
26. Juli 2021

• References

• 1 Aherne W, Hull D. Brown adipose tissue and heat production in the newborn infant. The J Pathol Bacteriol 1966; 91: 223-34
• 2 Miller SF. Resolution of calcific brown fat necrosis associated with prostaglandin therapy for cyanotic congenital heart disease in neonates: Report of two cases. Pediatr Radiol 2004; 34: 919-23
• 3 Stephenson TJ, Variend S. Visceral brown fat necrosis in postperinatal mortality. J Clin Pathol 1987; 40: 896-900
• 4 Akin MA, Akin L, Sarici D, Yilmaz I, Balkanli S, Kurtoglu S. Follow-up during early infancey of newborns diagnosed with subcutaneous fat necrosis. J Clin Res Pediatr Endocrinol 2011; 3: 216-8
• 5 Akcay A, Akar M, Oncel Y, Kizilelema A, Erdeve O, Oguz SS. et al. Hypercalcemia Due to Subcutaneous Fat Necrosis in a Newborn After Total Body Cooling. Pediatr Dermatol 2013; 30: 120-3
• 6 Shumer DE, Thaker V, Taylor GA, Wassner AJ. Severe hypercalcemia due to subcutaneous fat necrosis: Presentation, management, and complications. Arch Dis Child Fetal Neonatal Ed 2014; 99: F419-21
• 7 Mitra S, Dove J, Somisetty SK. Subcutaneous fat necrosis in newborn-an unusual case and review of literature. Eur J Pediatr 2011; 170: 1107-10
• 8 Raboi CA, Smith W. Brown fat necrosis in the setting of congenital heart disease and prostaglandin e1 use: A case report. Pediatr Radiol 1999; 29: 61-3
• 9 Herman TE, Siegel MJ. Special imaging casebook. hypoplastic left heart, prostaglandin therapy gastric focal foveolar hyperplasia and brown fat necrosis. J Perinatol 2001; 21: 263-5
• 10 Burden AD, Krafchik BR. Subcutaneous fat necrosis of the newborn: A review of 11 cases. Pediatr Dermatol 1999; 16: 384-7
• 11 Dudnik J, Walther FJ, Beekman RP. Subcutaneous fat necrosis of the newborn: Hypercalcemia with hepatic and atrial myocardial calcification. Arch Dis Child Fetal Neonatal Ed 2003; 88: F343-5
• 12 Grass B, Weiel L, Hagmann C, Brotschi B. Subcutaneous fat necrosis in neonates with hypoxic ischaemic encephalopathy registered in the swiss national asphyxia and cooling register. BMC Pediatr 2015; 15: 73