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

  congenital anomalies 7 (39) Khetarpal and Subrahmanyam 15 (1964) 17 Most preterm 11:6 Within first 7 days of birth 15 had no complications Comorbidities: septicemia, jaundice 3 (17.6) Villacorte and Frank 3 (1967) 9 Most preterm 6:3 Within first 7 days [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]

• 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]

• Breast Engorgement

  engorgement of newborn P83.5 - Congenital hydrocele P83.6 - Umbilical polyp of newborn P83.8 - Other specified conditions of integument specific to fetus and newborn P83.9 - Condition of integument specific to fetus and newborn, unspecified Contact About [icd-code.org]

  engorgement in newborn 778.8 - Other specified conditions involving the integument of fetus and newborn 778.9 - Unspecified condition involving the integument and temperature regulation of fetus and newborn Browse Medical Billing and Coding Databases [emedcodes.com]

  engorgement in newborn 778.8 Other specified conditions involving the integument of fetus and newborn 778.9 Unspecified condition involving the integument and temperature regulation of fetus and newborn This page was last updated on: 10/1/2014 [healthprovidersdata.com]

  engorgement of newborn P83.5 Congenital hydrocele P83.6 Umbilical polyp of newborn P83.8 Other specified conditions of integument specific to newborn P83.81 Umbilical granuloma Reimbursement claims with a date of service on or after October 1, 2015 require [icd10data.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]

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.