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Zeb, Amna MD*; Rosenberg, Rebecca E. MD, MPH*; Ahmed, ASM Nawshad Uddin FCPS; Saha, Samir K. PhD§; Chowdhury, MAK Azad FRCP; Ahmed, Saifuddin PhD; Darmstadt, Gary L. MD, MS*

The Pediatric Infectious Disease Journal: May 2009 - Volume 28 - Issue 5 - p 435-438
doi: 10.1097/INF.0b013e3181951af4
Brief Reports

Background: This study presents a retrospective analysis of risk factors for sclerema neonatorum in preterm neonates in Bangladesh.

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. Four hundred ninety-seven neonates were enrolled in the study and 51 (10.3%) developed sclerema neonatorum. We explored risk factors for sclerema neonatorum by comparing patients with and without sclerema neonatorum. Diagnosis of sclerema neonatorum was based on the presence of uniform hardening of skin and subcutaneous tissues to the extent that the skin could not be pitted nor picked up and pinched into a fold. Cultures of blood and cerebrospinal fluid were obtained in all neonates with clinical suspicion of sepsis.

Results: In multivariate analysis, lower maternal education (OR: 1.94; 95% CI: 1.02–3.69; P = 0.043), and signs of jaundice (OR: 2.82; 95% CI: 1.19–6.69; P = 0.018) and poor feeding (OR: 4.71; 95% CI: 1.02–21.74; P = 0.047) on admission were risk factors for developing sclerema neonatorum. The incidence rate ratio of sepsis in neonates who developed sclerema neonatorum was 1.81 (95% CI: 1.16–2.73; P = 0.004), primarily due to Gram-negative pathogens, and risk of death in infants with sclerema neonatorum was 46.5-fold higher (P < 0.001, 95% CI: 6.37–339.81) than for those without sclerema neonatorum.

Conclusions: Sclerema neonatorum was a relatively common, grave condition in this setting, heralded by poor feeding, jaundice, and bacteremia, and signaling the need for prompt antibiotic treatment.


From the *Department of International Health, International Center for Advancing Neonatal Health; and †Department of Population and Family Health Sciences, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; ‡Department of Pediatrics, Kumudini Women's Medical College, Mirzapur, Tangail, Bangladesh; §Department of Microbiology; and ¶Department of Neonatology Bangladesh Institute of Child Health, Dhaka Shishu Hospital, Dhaka, Bangladesh.

Accepted for publication November 13, 2008.

Supported by Thrasher Research Fund; the Office of Health, Infectious Diseases and Nutrition, Global Health Bureau, United States Agency for International Development (USAID) (award HRN-A-00-96-90006-00); and Save the Children-US through a grant from the Bill and Melinda Gates Foundation.

Address for correspodence: Gary L. Darmstadt, MD, MS, Integrated Health Solutions Development, Global Health Program, Bill & Melinda Gates Foundation,P.O.Box23350,Seattle,WA98102.E-mail:

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© 2009 Lippincott Williams & Wilkins, Inc.