Background: Subcutaneous fat necrosis (SCFN) of the newborn is an uncommon disorder that occurs in the first weeks of life after foetal distress. It can be complicated by potentially life-threatening hypercalcemia. Treatments of hypercalcemia have included hydration, furosemide and corticosteroids. Only one report has described the use of intravenous bisphosphonates for this condition. We propose that pamidronate could be the first line therapy for severe hypercalcemia in SCFN. Patients and Results: Four newborns presented between 2001 and 2004 with SCFN complicated by severe hypercalcemia. At diagnosis, ionized calcium levels were higher than 1.4 mmol/l and were associated with high urinary calcium/creatinine ratios and high 1,25-dihydroxyvitamin D levels. Despite treatment with IV fluids, low calcium diet and furosemide, calcium levels remained high. The patients were given 3–4 doses (0.25–0.50 mg/kg/dose) of pamidronate. Urinary calcium/creatinine ratios and calcium levels decreased within 48–96 h. 1,25-dihydroxyvitamin D levels normalized with resolution of the skin lesions. No persistent nephrocalcinosis was observed. Conclusion: Pamidronate is effective, well-tolerated in the short-term and obviates the need for prolonged treatment with furosemide and corticosteroids. To prevent nephrocalcinosis, pamidronate might be considered as first line treatment for severe hypercalcemia in SCFN.

Gu LL, Daneman A, Binet A, Kooh SW: Nephrocalcinosis and nephrolithiasis due to subcutaneous fat necrosis with hypercalcemia in two full-term asphyxiated neonates: sonographic findings. Pediatr Radiol 1995;25:142–144.
Finne PH, Sanderud J, Aksnes L, Bratlid D, Aarskog D: Hypercalcemia with increased and unregulated 1,25-dihydroxyvitamin D production in a neonate with subcutaneous fat necrosis. J Pediatr 1988;112:792–794.
Cook JS, Stone MS, Hansen JR: Hypercalcemia in association with subcutaneous fat necrosis of the newborn: studies of calcium-regulating hormones. Pediatrics 1992;90(Pt 1): 93–96.
Khan N, Licata A, Rogers D: Intravenous bisphosphonate for hypercalcemia accompanying subcutaneous fat necrosis: a novel treatment approach. Clin Pediatr (Phila) 2001;40:217–219.
Sargent JD, Stukel TA, Kresel J, Klein RZ: Normal values for random urinary calcium to creatinine ratios in infancy. J Pediatr 1993;123:393–397.
Plotkin H, Rauch F, Bishop NJ, Montpetit K, Ruck-Gibis J, Travers R, Glorieux FH: Pamidronate treatment of severe osteogenesis imperfecta in children under 3 years of age. J Clin Endocrinol Metab 2000;85:1846–1850.
Glover MT, Catterall MD, Atherton DJ: Subcutaneous fat necrosis in two infants after hypothermic cardiac surgery. Pediatr Dermatol 1991;8:210–212.
Tran JT, Sheth AP: Complications of subcutaneous fat necrosis of the newborn: a case report and review of the literature. Pediatr Dermatol 2003;20:257–261.
Balazs M: Subcutaneous fat necrosis of the newborn with emphasis on ultrastructural studies. Int J Dermatol 1987;26:227–230.
Norwood-Galloway A, Lebwohl M, Phelps RG, Raucher H: Subcutaneous fat necrosis of the newborn with hypercalcemia. J Am Acad Dermatol 1987;16(Pt 2):435–439.
Dudink J, Walther FJ, Beekman RP: Subcutaneous fat necrosis of the newborn: hypercalcaemia with hepatic and atrial myocardial calcification. Arch Dis Child Fetal Neonatal Ed 2003;88:F343–F345.
Drut R, Drut RM, Greco MA: Massive myocardial calcification in the perinatal period. Pediatr Dev Pathol 1998;1:366–374.
Kruse K, Irle U, Uhlig R: Elevated 1,25-dihydroxyvitamin D serum concentrations in infants with subcutaneous fat necrosis. J Pediatr 1993;122:460–463.
Sabokbar A, Pandey R, Athanasou NA: The effect of particle size and electrical charge on macrophage-osteoclast differentiation and bone resorption. J Mater Sci Mater Med 2003;14:731–738.
Cranefield DJ, Odd DE, Harding JE, Teele RL: High incidence of nephrocalcinosis in extremely preterm infants treated with dexamethasone. Pediatr Radiol 2004;34:138–142.
Alon US, Scagliotti D, Garola RE: Nephrocalcinosis and nephrolithiasis in infants with congestive heart failure treated with furosemide. J Pediatr 1994;125:149–151.
Bachrach LK, Lum CK: Etidronate in subcutaneous fat necrosis of the newborn. J Pediatr 1999;135:530–531.
Rice AM, Rivkees SA: Etidronate therapy for hypercalcemia in subcutaneous fat necrosis of the newborn. J Pediatr 1999;134:349–351.
Ezgu FS, Buyan N, Gunduz M, Tumer L, Okur I, Hasanoglu A: Vitamin D intoxication and hypercalcaemia in an infant treated with pamidronate infusions. Eur J Pediatr 2004;163:163–165.
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