Sclerema neonatorum is very rarely encountered in clinical practice. Reports have shown preterm newborns that suffer from respiratory distress or other delivery complications are at greatest risk for this rare form of panniculitis, whereas eclampsia has also been considered as a risk factor [1]. Symptoms most frequently appear during the first few days after birth but the period of symptom onset may range from immediately after birth to late neonatal period [2]. Due to deposition of triglyceride crystals in the subcutaneous tissue, which occurs through still undisclosed mechanisms in sepsis, profound hypothermia, hypoxemia, acidosis, and hypocalcemia [3], neonates suffer from profound hardening of the skin that is smooth, hard, and purplish in color [2]. The proximal parts of the lower limbs (buttocks or thighs) are sites where skin changes initially develop, but when such changes are seen on the thorax, breathing and feeding difficulties may ensue, as the skin cannot be picked up and is firmly bound to the subcutaneous tissue overlying the muscles and bones [2] [4]. Changes often spread to the entire body, sparing the fat-free soles, palms and genitalia [1], and mortality rates range from 30-100%, due to a progressive decline in body temperature, pulse and respiratory rate [2] [4].

• Multiple Congenital Anomalies

  SN is characterized by hardening of the skin that gets bound down to the underlying muscle and bone, hindering respiration and feeding and is associated with congenital anomalies, cyanosis, respiratory illnesses and sepsis. [researchgate.net]

• Bradypnea

  Objective Data Tachypnea with shallow respifection related to decreased ratory movement. immunologic function in the Bradypnea following a period of newborn. tachypnea (signals onset of reExpected Outcome spiratory failure). [kundoc.com]

• Decreased Bowel Sounds

  Decreasing bowel sounds Problem Four Nursing Diagnosis Alteration in ability to fight in-. . [kundoc.com]

• Muscle Contracture

  contractures and anomalies of pigmentation. [medigoo.com]

• Grieving

  Respect family’s need for grieving and for privacy. Make appropriate referrals to Social Service Department or Spiritual Care Department. Provide for follow-up home visits with family after infant’s death or dismissal from hospital. [kundoc.com]

The diagnosis of sclerema neonatorum should be easy to make based on clinical criteria and the observation of typical skin changes within the first few days or weeks of life. Having in mind this fact, a thorough but rapid examination of the newborn is the most important step in the workup. Furthermore, establishing risk factors can aid in solidifying the diagnosis of sclerema neonatorum as the underlying cause. Imaging or laboratory studies are used primarily for evaluation of conditions associated with this rare skin disorder. Chest X-rays or computed tomography (CT) are essential for the assessment of the cardiorespiratory system, whereas inflammatory markers, a complete blood count (CBC), and a full biochemical panel (bilirubin, liver and kidney function tests, etc.) are vital if valid clinical suspicion toward sepsis exists. Histopathological studies of the skin in sclerema neonatorum show completely normal epidermis and dermis, with broadened trabeculae and diminished fat spaces, and an inflammatory infiltrate without signs of necrosis[2]. However, the presence of needle-shaped crystals (formed from triglycerides, stearic and palmitic acids) in adipocytes is considered to be a hallmark of this condition [2].

• Potassium Decreased

  Change in behavior Closely monitor infant’s BUN, Increasing periods of apnea creatinine, and potassium. Decreasing bowel sounds Problem Four Nursing Diagnosis Alteration in ability to fight in-. . [kundoc.com]

• Lymphocytic Infiltrate

  Lymphocytic infiltrate around blood vessels and collagen bundles; thickened collagen replaces subcutaneous fat. Normal appearing epidermis; swollen dermal collagen; normal blood vessels. Subsides in 3-24 months. Localized atrophy and hyalinization. [kundoc.com]

  Omenn syndrome and graft versus host disease are characterized by dermal and epidermal lymphocytic infiltration and keratinocyte necrosis with satellite lymphocytes. [ijdvl.com]

Few clinical trials have been performed to address potential treatments. Successful treatment has been achieved via exchange transfusion (ET), but its use in neonates is declining. [ncbi.nlm.nih.gov]

No effective treatment. Good. Spontaneous resolution in 3-5 years, leaving a brown pigmentation. Time is only treatment. Good; may be residual deformities. [kundoc.com]

Treatment Options Treatment is supportive. Monitor fluid status, electrolytes, evaluate for sources of sepsis or other stress. Survival is uncommon. Treatment with systemic steroids and therapeutic warming has not improved survival. [clinicaladvisor.com]

The prognosis is poor if it becomes generalized. [medical-dictionary.thefreedictionary.com]

The prognosis of SN is generally very poor, with a high fatality rate. We report the case of a full-term infant with delayed onset of SN showing good prognosis. [ncbi.nlm.nih.gov]

Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. [icd10coded.com]

This review attempts to put into perspective their similarities and differences in light of historical, biochemical, pathologic, and etiologic considerations. Recent therapeutic modalities and the prognosis are discussed. [ncbi.nlm.nih.gov]

Although etiology is uncertain, associations include hypoglycemia, sepsis, shock, hypothermia, metabolic abnormalities, and other serious underlying illnesses. Prognosis is poor. [visualdx.com]

Dehydration, weakness, low body temperature and acidosis have all been considered as etiological factors. Several theories have been proposed including low oleic acid content of fat plus a low body temperature. [medigoo.com]

Certain etiologic considerations. J Invest Dermatol 12: 331, 1949 Google Scholar | Crossref | Medline Horsfield GI, Yardley HT : Sclerema neonatorum. [journals.sagepub.com]

Epidemiology and predisposing factors for erythema toxicum neonatorum and transient neonatal pustular melanosis. A case of tetanus neonatorum unsuccessfully treated with tetanus antitoxin. [yogavanahill.com]

[…] syndrome, congenital heart defects, gastroenteritis, intestinal obstruction, and severe malnutrition. [2, 5, 6, 7] Two case reports have described sclerema neonatorum that developed after therapeutic hypothermia initiated for neonatal asphyxia. [8, 9] Epidemiology [emedicine.medscape.com]

Reconstucting transmission with epidemiological analysis and whole-genome sequencing. BMJ (2015) 5:e007397. doi: 10.1136/bmjopen-2014-007397 PubMed Abstract | CrossRef Full Text | Google Scholar 10. [frontiersin.org]

Diagnosis One of the problems in identiT h e pathophysiological occurfying sclerema is its similarity to rences in sclerema are somewhat other diseases of the integumentary obscure: histological studies show system. [kundoc.com]

Etiologies and pathophysiology Symptoms Diagnosis Treatment 3. [slideshare.net]

Pathophysiology In an infant, fat has a higher saturated-to-unsaturated fatty acid ratio compared to adult fat and thus, a higher melting point. [emedicine.medscape.com]

Etiology Pathophysiology SN is likely a final common pathway of many different types of severe stresses leading to crystal formation and solidification of the saturated fats more prevalent in newborns. [clinicaladvisor.com]

METHODS: Preterm neonates admitted to Dhaka Shishu Hospital in Bangladesh were enrolled in a clinical trial to evaluate the effects of topical treatment with skin barrier-enhancing emollients on prevention of sepsis and mortality. [jhu.pure.elsevier.com]

Although IVIG did not prevent our patient's death, further studies are needed to determine its clinical utility in the treatment of this rare disorder. [ncbi.nlm.nih.gov]

Although IVIG did not prevent our patient’s death, further studies are needed to determine its clinical utility in the treatment of this rare disorder. [mdedge.com]

Your skin Holds body fluids in, preventing dehydration Keeps harmful microbes out, preventing infections Helps you feel things like heat, cold, and pain Keeps your body temperature even Makes vitamin D when the sun shines on it Anything that irritates [icdlist.com]

1. Buster KJ, Burford HN, Stewart FA, Sellheyer K, Hughey LC. Sclerema neonatorum treated with intravenous immunoglobulin: a case report and review of treatments. Cutis. 2013;92(2):83-87.
2. Zeb A, Darmstadt GL. Sclerema neonatorum: a review of nomenclature, clinical presentation, histological features, differential diagnoses and management. J Perinatol. 2008;28(7):453-460.
3. Navarini‐Meury S, Schneider J, Bührer C. Sclerema neonatorum after therapeutic whole‐body hypothermia. Arch Dis Child Fetal Neonatal Ed. 2007;92(4):F307.
4. Afroze F, Pietroni MAC, Chisti MJ. Recurrent Sclerema in a Young Infant Presenting with Severe Sepsis and Severe Pneumonia: An Uncommon but Extremely Life-threatening Condition. J Health Popul Nutr. 2013;31(4):538-542.