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THE JOURNAL OF THE JAPAN PEDIATRIC SOCIETY
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Vol.116, No.4, April 2012
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Original Article
Title
Choice and Efficacy of Intravenous Antiepileptic Drugs for Status Epilepticus in Children
Author
Kenjiro Kikuchi1)2) Shin-ichiro Hamano1) Ryuki Matsuura1)2) Kotoko Sugaya1) Manabu Tanaka1) Motoyuki Minamitani3) and Hiroyuki Ida2)
1)Division of Neurology, Saitama Children's Medical Center
2)Department of Pediatrics, Jikei University School of Medicine
3)Department for Child Health and Human Development, Saitama Children's Medical Center
Abstract
Objectives: The aim of our study was to evaluate the choice and efficacy of intravenous antiepileptic drugs (AEDs) for status epilepticus in children.
Methods: We retrospectively reviewed medical records of children with status epilepticus (SE) in our institution. The criteria of SE was defined as any seizure lasting for more than 30 minutes or intermittent seizures from which the children did not regain consciousness. We evaluated the effectiveness of AEDs as follows: "Effective" represented a cessation of seizures for more than 24 hours after administration, and "Non-effective" represented a recurrence of seizures within 24 hours after administration. In the present study, we evaluated the efficacy of intravenous midazolam (MDL) and continuous infusion MDL respectively.
Results: 189 SE episodes in 155 children (89 boys, 66 girls: median age, 2.7 years) were enrolled. Etiologies of SE were epilepsy in 42.3%, febrile seizure in 41.3%, and acute encephalopathy/encephalitis in 11.1%. Twelve SE episodes (6.3%) ceased without AED administration. Diazepam (DZP) was administered most frequently as first-line AEDs following intravenous MDL. As second-line AEDs, intravenous MDL was most common following phenobarbital (PB), and as third-line, PB was most frequently given following continuous infusion of MDL. Efficacy rate (effective episodes/administered episodes) was as follows: PB (71.1%), DZP (70.1%), thiopental (57.1), continuous infusion MDL (55.6%), intravenous MDL (43.1%), phenytoin (38.5%), and lidocaine (0.0%), respectively. Adverse effects of thiopental were found most frequently following continuous infusion of MDL and PB.
Conclusions: We consider that DZP as first-line AEDs for SE and PB and intravenous MDL as second-line may be practical and that thiopental may be third- or fourth-line AEDs.
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Original Article
Title
Follow up of Children with Vesicoureteral Reflux without Antibiotic Prophylaxis
Author
Tomoo Kise1) Shigeru Fukuyama1) Hiroshi Yoshimura1)2) Itaru Iwama2) and Fumiko Miyake2)
1)Department of Pediatrics, Prefectural Okinawa Nanbu Medical Center and Children's Medical Center
2)Department of Pediatrics, Prefectural Okinawa Chubu Hospital
Abstract
We report on the follow up of children with vesicoureteral reflux (VUR) without antibiotic prophylaxis. Patients with VUR, diagnosed by cystourethrography after a first episode of acute pyelonephritis, were followed with serial urine cultures every month. If urine culture collected in a bag was positive, we obtained urine specimens by transurethral bladder catheterization and the patient was started on oral antibiotics. We defined cystitis in children without fever, by positive culture of urine obtained by catheterization. Children with fever were treated with intravenous antibiotics after urine was collected by transurethral bladder catheterization. If the urine culture obtained by catheterization was positive, we defined the episode as recurrent pyelonephritis. At each episode of recurrence, with or without fever, we discussed antibiotics prophylaxis initiation with the family. Thirty-three patients with VUR were divided into two groups. There were 21 patients with VUR grade I, II or III in Group A, and 12 patients with VUR grade IV or V in Group B. In group A, 28% (6/21) of children had at least one urinary tract infection (UTI) recurrence including cystitis and pyelonephritis. However, 90% (10/12) of children in Group B had UTI recurrence. In Group A, the 6 patients with recurrence had 5 episodes of cystitis and 3 of pyelonephritis. In Group B, 10 patients had 1 episode of cystitis and 16 of pyelonephritis. No child in Group A received antibiotic prophylaxis while six in Group B received antibiotic propylaxis. Four children in Group B were referred to the urology department for surgery because of recurrence after starting antibiotic prophylaxis. Our follow up of VUR without antibiotic prophylaxis was associated with a low rate of pyelonephritis recurrence in children with VUR grade I, II, and III. On the other hand, children with VUR grade IV and V developed reccurrent pyelonephritis in spite of antibiotic prophylaxis, suggesting the need for close monitoring with appropriate surgical consultation in this group.
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Original Article
Title
Linezolid-resistant Methicillin-resistant Staphylococcus aureus (MRSA) Detected from an Infant with Congenital Ichthyosiform Erythroderma during Linezolid Treatment of Infective Endocarditis
Author
Hiroyuki Adachi1) Hirokazu Arai1) Tomoo Ito1) Hiroyuki Kayaba2) and Tsutomu Takahashi1)
1)Department of Pediatrics, Akita University Graduate School of Medicine
2)Department of Infection, Allergy, Clinical Immunology and Laboratory Medicine, Akita University Graduate School of Medicine
Abstract
In Japan, the use of linezolid to treat methicillin-resistant Staphylococcus aureus (MRSA) infection was approved in 2006. To date, linezolid-resistant MRSA has been very rare in Japan. A male infant was admitted to our institute with congenital ichthyosiform erythroderma on the first day of life. Two weeks later, he developed MRSA infective endocarditis and vancomycin was not effective. As an alternative, linezolid was administered and was very effective. During linezolid treatment, MRSA was continuously detected from his skin. After 6 weeks of linezolid administration, linezolid-resistant MRSA was detected (minimum inhibitory concentration: MIC>4 μg/ml). However, infective endocarditis did not deteriorate. Two weeks after the discontinuation of linezolid, the MIC of linezolid against MRSA improved to <2 μg/ml. Recently, increases in the MIC of VCM against MRSA have been reported worldwide (i.e. MIC creep). In our MRSA strains, the MIC of VCM against MRSA was 2 μg/ml, which is at the high end of the susceptibility range. With the decreased effectiveness of vancomycin for MRSA, the frequency of linezolid administration is expected to increase. Linezolid-resistant MRSA is currently rare, but may develop with long-term administration of linezolid and in carriers of MRSA receiving linezolid treatment.
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Original Article
Title
Nontyphoidal Salmonella Encephalopathy Associated with Convulsion and Elevation of Serum Creatine Kinase
Author
Ryuki Matsuura1)2) Shin-ichiro Hamano1) Kenjiro Kikuchi1)3) Akifumi Yamada3) Reiji Ito3)4) Yasuyuki Wada2) Masakatsu Kubo2) Seiichi Kagimoto5) and Hiroyuki Ida3)
1)Division of Neurology, Saitama Children's Medical Center
2)Department of Pediatrics, Kashiwa Hospital, The Jikei University School of Medicine
3)Department of Pediatrics, The Jikei University School of Medicine
4)Division of Cardiology, Saitama Children's Medical Center
5)Division of General Pediatrics, Saitama Children's Medical Center
Abstract
Nontyphoidal Salmonella enteritidis infection is a common human infection but is rarely associated with severe extraintestinal complications and encephalopathy.
We report 2 patients who had encephalopathy associated with nontyphoidal S. enteritidis infection.
Case 1. An 8-year-old boy had fever, diarrhea, vomiting, convulsion, and lost consciousness. S. enteritidis phage type 9 was isolated from his stool. Laboratory investigations showed that the creatinine kinase (CK) level was 6,080 IU/l. The electroencephalogram showed a generalized diffuse high-voltage slow wave. Cerebral blood flow scintigraphy showed decreased perfusion in both inferior temporal lobes. He was given antibiotics, γ-globulin, dexamethasone and glycerol. He recovered without sequelae.
Case 2. A 2-year-old girl had fever, diarrhea, and convulsions. S. enteritidis phage type 9 was isolated from her stool. Laboratory investigations showed that the CK level was 747 IU/l. Electroencephalogram showed a diffuse high-voltage slow wave. Cerebral blood flow scintigraphy showed diffuse cerebral and cerebellar hypoperfusion. She was given antibiotics, edaravone, dexamethasone, and glycerol. She could neither stand nor speak at 2 years of age.
S. enteritidis may cause encephalopathy and a complication of rhabdomyolysis. We must therefore be careful about S. enteritidis, because patients may suffer from sequelae.
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Original Article
Title
An Infant with Trisomy 13 and Cerebral Infarction
Author
Masaharu Moroto1)3) Nobuto Mitsufuji2) Minako Kihara2) Zenrou Kizaki3) Masafumi Morimoto1) and Hajime Hosoi1)
1)Department of Pediatrics, Kyoto Prefectural University of Medicine
2)Department of Neonatology, Kyoto First Red Cross Hospital
3)Department of Pediatrics, Kyoto First Red Cross Hospital
Abstract
An infant with trisomy 13 presented with cerebral infarction of the left putamen.
At birth, he had multiple malformations, and so we performed G-banding. He was given a diagnosis of trisomy 13, but did not show life-threatening congenital heart disease nor central nervous system malformation. He was discharged from the NICU on the 49th postnatal day, and experienced no problems until 2 years old.
Although EEG abnormality was confirmed at 2 years old, he did not show convulsions. One month later, he repeatedly showed weakness of the left side of the body; therefore, he was brought to the emergency room to re-check his EEG. Since EEG abnormality was reconfirmed, we diagnosed epileptic seizure and administered diazepam anally. He did not show improvement, and we diagnosed cerebral infarction based on MRI on day 5 of the disease. His repetitive weakness was caused by TIA, and progressed to infarction.
The symptom improved through rehabilitation, and he is now age 5 without recurrence.
Trisomy 13 is generally considered lethal, but long-surviving cases are occasionally documented. After late infancy, complications of trisomy 13 are rarely documented. We could not find a report of an infant with trisomy 13 and cerebral infarction in the literature. When we follow patients with trisomy 13, we have to pay attention to cerebral infarction.
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Title
Human Parechovirus Type 3 Infection in a Neonate and 3 Infants
Author
Kota Ao1) Aki Tanaka1) Hiroki Shiojima1) Fumiyo Hirabayashi1) Kanako Shirai1) Atsushi Isozaki1) Yukiko Osawa1) Nobuyuki Kikuchi1) Masaaki Mori2) and Shumpei Yokota3)
1)Department of Pediatrics, Yokohama Minato Red Cross Hospital
2)Department of Pediatrics, Yokohama City University Medical Center
3)Department of Pediatrics, Yokohama City University Graduate School of Medicine
Abstract
Human parechovirus-1 (HPeV-1) and HPeV-2, initially known as echovirus-22 (EV-22) and EV-23, are causative agents of gastroenteritis, respiratory symptoms, and, in smaller proportion of cases, sepsis-like symptoms/signs and neonatal encephalitis. Around 16 different types of HPeV are listed now. We experienced, between 21st and 29th, July in 2011, 5 neonates and infant with high fever, poor feeding, and somnolence, and among them 4 cases were demonstrated HPeV-3 in stool samples. High fever was persisted for 3-4 days, and all the cases were recovered uneventfully. In the present cases, there were no cases who progressed to viral sepsis, central nervous system-related diseases, or sudden unexplained infant death. However, reports which indicated severe sepsis and encephalitis appeared in the literature, it may be important to differentiate HPeV infection especially in neonates/infant who manifests high fever.
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