Incidence and risk factor profile for subcutaneous fat necrosis among newborns undergoing therapeutic hypothermia: a multi-center regional cohort

Objective To determine the incidence, risk factors, and outcomes associated with subcutaneous fat necrosis (SCFN) in a regional cohort of newborns treated with therapeutic hypothermia (TH) for neonatal encephalopathy (NE). Study design Data from a regional Neonatal Encephalopathy Registry was retrospectively analysed. All newborns treated with TH between 2018 and 2022 were included. The primary outcome was the incidence of SCFN. Secondary outcomes included associated risk factors and complications. Results SCFN occurred in 4% of newborns (20/499) undergoing TH. Factors associated with SCFN included elevated maternal BMI, maternal preeclampsia/hypertension, pyrexia during labor, earlier initiation of active cooling, thrombocytopenia, and blood product administration. Half of the SCFN cases developed hypercalcemia. SCFN was associated with longer hospital stay (median 11.5 vs. 8 days, p = 0.007). Conclusion In this large, contemporary cohort, SCFN occurred in 4% of newborns with NE treated with TH. Enhanced monitoring and risk stratification may facilitate early diagnosis and improve management outcomes.