Expert Opinion :
This child has subcutaneous fat necrosis which may be due to birth asphyxia (she was meconium aspiration and required ventilatory support). Subcutaneous fat necrosis can lead to hypercalcemia due to excessive production of 1, 25 dihydroxy Vitamin D in the necrosed fat. Hence this child should be screened for hypercalcemia. This child’s serum calcium was elevated (12.4 mg%) and ionic calcium was 2.28 mmol/L). This hypercalcemia may be life threatening and can lead to cardiac asystole. Another problem can be ectopic deposition of calcium in the body especially the kidneys. Thus the child should also be screened for nephrocalcinosis and renal dysfunction. The USG kidneys did show nephrocalcinosis and the child had hypercalciuria. Renal function tests were normal. The child now needs to be treated for hypercalcemia.