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P114 Also adipose tissue pays consequencies of perinatal asphyxia
  1. Clementina Calabrese2,
  2. Alessandra Marinari1,
  3. Lucia Taurino1,
  4. Alessandra Catucci1,
  5. Lorenza Chiossi2,
  6. Salvatore Cringoli2,
  7. Francesca Lotti2,
  8. Pio Liberatore2,
  9. Antonella Coretti2,
  10. Valeria Verrotti di Pianella2,
  11. Rosario Magaldi1,
  12. Massimo Pettoello-Mantovani2
  1. 1STRUTTURA COMPLESSA DI NEONATOLOGIA E TERAPIA INTENSIVA NEONATALE – OSPEDALE RIUNITI DI FOGGIA
  2. 2SCUOLA DI SPECIALIZZAZIONE IN PEDIATRIA, UNIVERSITÀ DEGLI STUDI DI FOGGIA

Abstract

D.R. is born at term of physiological pregnancy by caesarean section. Birth weight was 3520 g, APGAR 7/9. At birth he presented axial hypotonia, hyporeactivity, groan, mild respiratory distress. Started Non Invasive Ventilation for 2 days with good improvement of outcome.

At 4 day life, we started antimicrobial therapy and immunoglobulins ev because of elevated inflammatory markers and low platelet counts (PLT 47000/mcl) confirmed at the blood smear.

After 2 weeks, on the neck and on the right cheek, finding of erythematous nodules of a few millimetres of diameter. In the days after, the lesions are also extended to the left cheek and became larger up to about 3 cm.

At the ultrasound they appeared as ‘delimited echogenic areas of 19 × 14 mm at left, 17 × 12 mm at right whit intrinsic vascularisation and of irregular structure. Laboratory pannels (hepatic, renal, coltural exams, procalcitonin) were negative, ESR 24 mm/h, CRP 23.6 mg/L.

About 30 days after, we see a reduction of the lesions in spite of a persistent increase of inflammatory markers. Therefore, a bacterial aetiology appeared ulikely saw that antimicrobial therapy so soon established, had no effects on them.

Subcutaneous fat necrosis of the newborn is a relatively rare and transient condition that appeared in the first weeks of life in term infants with a perinatal suffering.

This condition is caractherized by single or multiple subcutaneous nodules, isolated or confluent in plaques, erythematous/purplish, sometimes with little depressions, calcifications or necrosis inside; symmetrically distributed on the back, shoulders, buttocks, cheeks and at the root of the limbs; often painful at palpation. These nodules grow for some weeks and completely resolve within few months.

Etiopathogenesis is probably linked to ischaemic injury, hypoxia, hypothermia and/or stress damage on the immature adipose tissue in infants with perinatal asphyxia.

Maternal hypertension, gestational diabetes, family history of thrombophilia and dyslipidemia are considered risk factors. The diagnosis is clinical; the cutaneous biopsy is of support. Important for diagnosis are also the Ultrasonography and RMN.

Hypercalcemia is the most dangerous complication; less frequent consequencies are thrombocytopenia, metabolic disorders (hypertriglyceridemia, hypoglycemia) and atrophic development of the nodular lesions.

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