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THE JOURNAL OF THE JAPAN PEDIATRIC SOCIETY
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Vol.114, No.7, July 2010
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Original Article
Title
A Prospective Study Comparing Ampicillin versus Sulbactam/Ampicillin for Lower Respiratory Tract Infection in Children
Author
Masayuki Kanno Akihiro Konno Hiroko Hayakawa Nao Uchida Emiko Suzuki Toshihiko Kashiwabara Satoshi Watanabe Toshihiko Uchida Satoru Aiba Masashi Watanabe and Jun-ichi Fujiyama
Department of Pediatrics, Yamagata Central Hospital
Abstract
We conducted a prospective study to compare ampicillin (ABPC) versus sulbactam/ampicillin (SBT/ABPC) as first-line antibiotic therapy for pediatric patients admitted with lower respiratory tract infection. From March 2007 to March 2008, patients admitted on alternate weeks were assigned to either the ABPC (100-120 mg/kg/day) or SBT/ABPC (150-180 mg/kg/day) groups. A total of 219 cases (206 patients) were enrolled in the study, with no differences in baseline characteristics between the 120 cases assigned to ABPC and 99 cases assigned to SBT/ABPC. During hospitalization, ABPC and SBT/ABPC were switched in 5 cases (4.2%) and 4 cases (4.0%), respectively, based on poor clinical response and/or side effects. In the remaining cases in which ABPC or SBT/ABPC treatment was completed, median defervescence time was 0.5 day (interquartile range, 0.5-1.0 day) for both groups. The most frequent side effect was diarrhea, which developed in 16.6% of ABPC patients and 15.2% of SBT/ABPC patients. These results indicate that ABPC and SBT/ABPC have comparable clinical efficacy and side effect profiles. Therefore, ABPC, without beta-lactamase inhibitors, appears to be adequate as primary therapy for the treatment of children admitted with lower respiratory tract infection.
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Original Article
Title
Trends in the Detection Rate of Penicillin Resistant Streptococcus Pneumonia between 2004 and 2008 in Our Hospital
Author
Yutaka Odanaka1) Takuya Tanabe1) Miwa Nakajima1) Hideki Matsumura1) Toshihiko Kasahara1) Maki Koh1) Keita Hara1) Keisuke Okasora1) and Hiroshi Tamai2)
1)Department of Pediatrics, Hirakata City Hospital
2)Department of Pediatrics, Osaka Medical College
Abstract
The aim of this study is to examine annual changes in the resistance rates of Streptococcus pneumoniae and in the prescription of antimicrobial drugs in our hospital. Subjects and Methods: One thousand seven hundred and ninety cases (average age 25.8±26.6 months) in whom Streptococcus pneumoniae was detected from nasopharyngeal cultures from April 2004 to March 2008 were studied. Subjects were divided into two groups; the pathogen group, in which detected Streptococcus pneumoniae was regarded as the cause of respiratory infectious disease, and the non-pathogen group in which the detections were made by chance with viral or mycoplasma infections. A penicillin MIC≥2 μg/ml was defined as penicillin resistant Streptococcus pneumoniae (PRSP), a penicillin MIC=0.12-1 μg/ml as penicillin low sensitivity Streptococcus pneumoniae (PISP), and a penicillin MIC≤0.06 μg/ml as penicillin-sensitive Streptococcus pneumoniae (PSSP). Results; PSSP increased significantly in the non-pathogen group during the examination period, while PISP and PRSP decreased significantly. Similar changes were observed in the pathogen group, although PRSP increased temporarily in 2005-6. Prescription of antimicrobial agents before culture was greatest, 80%, in the 2005-6 period. The rate gradually decreased in the 2006-7 and the 2007-8 periods. The antimicrobial prescription rate before culture was significantly higher with PRSP than with PSSP. As for the prescription, penicillins showed a tendency to increase, though cephalosporins tended to decrease. Discussion: The resistance rates of Streptococcus pneumoniae decreased. It was suggested that the decreased prescription rate and shift from penicillins to cephalosporins might play an important role in the prevention of increasing bacterial resistance.
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Original Article
Title
Neurological Outcomes in Premature Infants Who Develop Late-onset Circulatory Dysfunction
Author
Nobuto Mitsufuji Akiko Kawakita Ai Hayashi Reiri Yamamura Yumiko Tokuhiro Yoshinobu Nakabayashi Hiroyuki Hamada and Minako Kihara
Department of Neonatology, Kyoto First Red Cross Hospital
Abstract
We retrospectively investigated the effects of late-onset circulatory dysfunction (LCD) on the neurological outcomes in premature infants. A total of 120 preterm infants who were delivered at <33 weeks of gestation were eligible for the study, 19 of whom had developed LCD. The risk factors for a poor neurological outcome included the onset of LCD and the duration of oxygen supply. The 19 infants were divided into 2 groups: (i) a good prognosis group comprising 8 infants with normal neurological development and (ii) a poor prognosis group comprising 11 with adverse neurological outcomes. In the poor prognosis group, 4 infants had mild spastic diplegia, 2 had spastic tetraplegia with severe mental retardation, and 3 had spastic tetraplegia with severe mental retardation and epilepsy; the remaining 2 infants had only mental retardation. There were no significant differences in perinatal characteristics including birth weight, gestational age, duration of both mechanical ventilation and oxygen supplementation, and incidence of laser treatment for retinopathy of prematurity between the two groups. The incidence of patent ductus arteriosus ligation was higher in the poor prognosis group. There were no significant differences in some characteristics at the onset of LCD, including body weight, postconception age, duration of anuria, serum sodium level, and amount of steroids administered. In the poor prognosis group, cystic periventricular leukomalacia was detected at 9-17 days after the onset of LCD in 7 infants, and brain magnetic resonance imaging revealed cystic changes in the cerebral white matter in 6 infants and an irregular ventricular margin in 2. Thus, LCD is an important factor that influences the neurological outcome in premature infants.
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Original Article
Title
A Questionnaire Survey on the Relationship between Playing in the Prone Position and Motor Development in Infancy
Author
Hajime Tanaka1) Ikue Fukuda1) Akie Miyamoto1) Ryuji Oka1) Yumi Kawata2) and Kazuhiko Cho1)
1)Department of Pediatrics, Asahikawa Habilitation Center for Disabled Children
2)Asahikawa Public Health Center
Abstract
A questionnaire survey was conducted to identify the relationship between playing in the prone position and motor development in infancy. This survey was intended for parents of one-year-old and six-month-old children undergoing medical check-ups in Asahikawa. Questionnaires were collected from the parents of 541 children (282 males, 259 females; mean age 18.1 months) enrolled in this survey. Forty percent answered that their children rarely played in the prone position, whereas 22% answered that their children frequently played in this position. The age of the child in months was determined when it attained the following four motor milestones: "able to change their position from supine to sitting", "creeping", "able to change their position from sitting to standing with support" and "walking". The children who frequently played in the prone position attained all four motor milestones earlier than the children who played rarely in this position; a significant difference was observed between the two groups. Sixty-five percent of the parents were not particularly concerned about their child playing in the prone position, whereas 5% of the parents prevented their child from doing so.
After the American Academy of Pediatrics recommended the supine position for sleep in infants to avoid sudden infant death syndrome, the incidence of prone positioning in sleep decreased markedly. Although it was reported that "supine position in sleep" does not influence motor development of infants, inexperience of playing in the prone position negatively affects motor milestones, as shown in this report. Therefore, playing in the prone position is a very important factor for development of infants because it increases the truncal muscle strength and exploratory behavior. In addition, prone position is the key position for changing posture, for example, from supine to sitting and from sitting to standing. Guidance should be given to parents to make them aware of these points.
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Original Article
Title
Two Infant Cases of Diphyllobothriasis Nihonkaiense Diagnosed Definitively by DNA Analysis of Causative Tapeworms
Author
Teruko Koide1) Hiroshi Yamasaki2) Nobuyuki Watanabe1) Izumi Kimoto1) and Takashi Kawabe1)
1)Department of Pediatrics, Kasugai City Hospital
2)Department of Parasitology, National Institute of Infectious Diseases
Abstract
Two infant cases with diphyllobothriasis nihonkaiense were reported. A boy and his sister naturally expelled proglottids after ingesting raw masu salmon (Oncorhynchus masou), which were caught in the rivers of Toyama Prefecture. The two patients were successfully treated with praziquantel at doses of 30 mg/kg. After deworming, the causative tapeworms were identified as Diphyllobothrium nihonkaiense by morphology of reproductive organs and mitochondrial DNA analysis. Recently, human diphyllobothriasis including children is increasingly reported. Identification of the Diphyllobothrium tapeworms is difficult due to their morphological similarities. Thus, if possible, accurate identification of the Diphyllobothrium species based on DNA analysis would be highly recommended.
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Original Article
Title
A Case of Mycoplasma pneumoniae-associated Bronchiolitis after Atypical Pneumonia in a 14-year-old Boy
Author
Toshinori Nakamura Takanari Fujii Takako Saito Junya Iwasaki and Kazuo Itahashi
Department of Pediatrics, Showa University
Abstract
We report a case of a 14-year-old boy who had prolonged severe respiratory distress and suffered bronchiolitis after atypical pneumonia caused by Mycoplasma pneumoniae (MP) infection. He was admitted to our hospital with a 5-day history of fever and respiratory distress. He had taken clarithromycin for 4 days before admission. Since his MP antibody titer and MP IgM value were both initially negative, we diagnosed pneumonia based on infiltrative shadows on a chest X-ray and administered ampicillin. Although he became afebrile on the 11th day and the pulmonary infiltrative shadows disappeared, his respiratory distress became more severe and chest CT on the 12th day revealed bronchiolitis. We changed the antibiotic to minocycline hydrochloride and added methylprednisolone (mPSL). We made a diagnosis of MP infection based on MP antibody titer elevation on the 18th day, which was more than four times higher than that on admission. His respiratory distress disappeared and he was discharged on the 20th day. However, his spirometric evaluation showed a pattern of peripheral airway obstruction. Considering the change in the chest X-rays and the efficacy of mPSL, the pathology may change from direct damage by MP infection to excess immunological activation.
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Original Article
Title
Two Siblings with Hyperekplexia Complicated by Paralytic Ileus
Author
Mako Ago1) Takeshi Taketani1)2) Masahiko Kimura1)3) Kenji Yasuda1) Koji Kumori4) Kazuko Kishi1) Hitoshi Sejima1)5) and Seiji Yamaguchi1)
1)Department of Pediatrics, Shimane University Faculty of Medicine
2)Division of Blood Transfusion, Shimane University Hospital
3)Kimura Children and Family Clinic
4)Department of Digestive and General Surgery, Shimane University Faculty of Medicine
5)Division of Pediatrics, Matsue Red Cross Hospital
Abstract
Hyperekplexia is a rare neurogenetic disorder characterized by hypertonia and exaggerated startle response from the neonatal period. This is caused by gene mutations for several genes encoding synaptic proteins involved in glycinergic neurotransmission. Concomitant features include abdominal hernia, hip dislocation, motor retardation, or even sudden infant death. We described two siblings with hyperekplexia caused by the mutation in the glycine receptor α1 subunit (GLRA1) gene, accompanied by paralytic ileus following surgical operation or acute gastroenteritis. Both 2 siblings showed generalized stiffness and umbilical hernia from early infancy. Head-retraction response after tapping the root of the nose was observed (positive nose tapping test). Three family members belonged to the paternal side had the exaggerated startle reflex. The genetic analysis demonstrated a heterogeneous missense mutation (Arg271Gln) of the GLRA1 gene in two siblings. Hence, they were diagnosed with familial hyperekplexia. Hypertonia of the extremities and exaggerated startle response improved with medication of clonazepam. They both developed paralytic ileus after surgical operation to umbilical hernia and at the onset of acute gastroenteritis. Patients with hyperekplexia are often misdiagnosed with spastic quadriplegia or epilepsy, and then might undergo unnecessary clinical tests or treatments. The prognosis of this disease is generally good after infancy, although startle reflexes remain up to adulthood. Therefore, it is important to make a precise diagnosis as early as possible, by the nose tapping test and genetic analysis in addition to physical findings. In thus report, we presented two siblings with hyperekplexia complicated by paralytic ileus. The pathogenesis of the paralytic ileus in these cases was claimed that patients with hyperekplexia might easily become to have autonomic lability, and that their abdominal pressure might excessively increase followed by postoperative pain.
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Original Article
Title
Diffuse Panbronchiolitis (DPB): A Case of a 9-year-old Girl
Author
Hazumu Nagata1) Takayuki Noguchi1) Yuka Mihara1) Keiichi Mitsui1) Yasuhumi Hidaka1) Junichirou Tezuka2) and Kenji Okada2)
1)Department of Pediatrics, Kitakyushu Municipal Medical Center
2)Department of Pediatrics, Fukuoka National Hospital
Abstract
DPB is well recognized in Japan and usually diagnosed in the second to fifth decade. Childhood DPB is rare. This case is the youngest DPB case ever.
We describe a 9-year-old girl complained of prolonged cough and wheeze. She received a diagnosis of uncontrolled asthma. She has been hospitalized on and off. When she was nine years old, she received a diagnosis of DPB. She had characteristic clinical symptoms for DPB and sinusitis. Plain chest radiography revealed diffuse nodular shadow and overinflation. Chest CT demonstrated diffuse centrilobular nodules and bronchiectasis. Furthermore she had coarse crackle and her titers of cold hemagglutinin elevated. Histopathological examination revealed infiltration of inflammation cell with foamy cells into alveoli and interstitial tissue. Radiographic feature improved by treatment with erythromycin for a month.
DPB is rare disease for pediatrician, and we may miss it. Pediatrician should know clinical and radiographic feature of DPB.
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Original Article
Title
Congenital Cystic Adenomatoid Malformation Type 4; A Case Report
Author
Satoru Kutsuna1) Idumi Katoh1) Fumie Nagai1) Katsuaki Abe1) Yuji Hashimoto1) Satoshi Anzai1) Toshiaki Jibiki1) Masaki Kanazawa1) Tomomichi Kurosaki1) Shintaro Kikuchi2) Masataka Higuchi2) and Kazuteru Kawasaki2)
1)Department of Pediatrics, Chiba Kaihin Municipal Hospital
2)Department of Respiratory Medicine, National Center for Child Health and Development
Abstract
We report a case of a one-month-old girl. At one month after birth, physical examination revealed respiratory distress and weight loss, and following a chest radiograph and spiral CT scan, we suspected congenital cystic adenomatoid malformation (CCAM). Due to her respiratory distress, we performed an emergency lobectomy of the right middle lobe through a standard right posterolateral thoracotomy. Her breathing had greatly improved at the time of discharge from the hospital, eight days after admission. She was diagnosed with CCAM type 4 according to histological findings. As CCAM can often cause tachypnea, retraction, and cyanosis in the neonatal period, it should be considered as a potential diagnosis in newborns who present with respiratory distress.
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