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THE JOURNAL OF THE JAPAN PEDIATRIC SOCIETY
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Vol.120, No.9, September 2016
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Original Article
Title
Current Status of Acute Medical Treatment for Children with Severe Motor Disabilities in an Emergency Department and a Pediatric Ward in Toyota City
Author
Yuji Ito1)2) Kiyokuni Miura2)3) Shinya Hara4) Yasuaki Kishimoto5) Akihiro Hirakawa6) Chikako Ogawa1)2) Hiroyuki Kidokoro1) Naoya Okumura4) Mitsuharu Kajita5) and Jun Natsume1)3)
1)Department of Pediatrics, Nagoya University Graduate School of Medicine
2)Department of Pediatric Neurology, Toyota Municipal Child Development Center
3)Developmental Disability Medicine, Nagoya University Graduate School of Medicine
4)Department of Pediatrics, Toyota Memorial Hospital
5)Department of Pediatrics, Toyota Kosei Hospital
6)Center for Advanced Medicine and Clinical Research, Nagoya University Hospital
Abstract
This study aimed to define the current status of acute medical treatment for children with severe motor disabilities (SMD) by retrospectively comparing medical records of 2-14-year-old children with or without SMD over a 5-year period at Toyota Memorial Hospital and Toyota Kosei Hospital.
The ratio of children entering the emergency department was higher among children with SMD during the 5-year period (RR=1.8-3.3) and the ratio of hospitalizations referred from the emergency department was higher among children with rather than those without SMD (46.2% vs. 4.2%). The ratio of children entering the pediatric ward was higher among children with SMD during the 5-year period (RR=12.2-19.3). The number of hospitalized children without SMD decreased over five years because the numbers of children admitted to the hospital with bronchitis and pneumonia also decreased. However, the number of children with SMD caused by various complications who were hospitalized did not decrease, and the ratio of such children admitted to the pediatric ward increased to 7.0% in 2013.
As the introduction of new vaccines has decreased the number of pediatric patients, the ratio of acute medical treatment for children with SMD is increasing. Medical treatment for SMD could be enhanced by establishing systems such as: 1) a cooperative system between acute-care hospitals and family doctors and visit care stations in order to enrich home medical care for children with SMD; 2) a cooperative system between acute-care and SMD-specializing hospitals in order to refer children with SMD from acute-care hospitals to optimal environments for treatment re-evaluation; and 3) a training system for medical staff of practical knowledge and techniques for care and treatment of children with SMD.
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Case Report
Title
Patent Ductus Venosus Manifesting as a Brain Abscess: A Case Report
Author
Dai Suzuki Fumihiko Kakuta Chiyo Hayashi Yohei Watanabe Akiko Yamaoka Hiroaki Umebayashi Tetsuji Inagaki Katsushi Miura and Daiki Abukawa
Department of General Pediatrics, Miyagi Children's Hospital
Abstract
We report the case of a 9-year-old boy who presented with patent ductus venosus manifesting as a brain abscess. He had mild mental retardation. He was admitted because of headache and drowsiness. A brain abscess was detected on head computed tomography (CT) and magnetic resonance imaging (MRI). The abscess was drained. He showed mild liver injury and hyperammonemia, hyperbileacidemia, hypoxemia, and intrapulmonary shunts; high signal intensity was observed at the basal ganglia on brain MRI. Initial abdominal contrast-enhanced CT and MRI showed multiple hepatic masses, which were histologically diagnosed as focal nodular hyperplasia (FNH), and an abnormal blood vessel, which on subsequent superior mesenteric artery angiography was seen connecting a portion of the portal vein to the inferior vena cava. We hence diagnosed patent ductus venosus. Surgical ligation and dissection of the ductus venosus under laparotomy were performed and no elevation in portal vein pressure was ascertained. A congenital portosystemic shunt (CPSS) manifesting as brain abscess is rare. We presume that the bacteria which invaded the portal blood flow gained access to the systemic circulation without being trapped in the reticuloendothelial system of the liver, causing the brain abscess. Brain abscesses should be considered as serious complications of CPSS, particularly those with a high-flow portosystemic shunt.
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Case Report
Title
Secondary Carnitine Deficiency after Low Dietary Intake and Two Days of Treatment with an Antibiotic Containing Pivalic Acid
Author
Fumihito Nozaki1) Takashi Kusunoki1) Yosuke Shigematsu2) Saeko Sasaki1) Tomohiro Kumada1) Minoru Shibata1) Anri Hayashi1) Mioko Mori1) Ikuko Hiejima1) Kenji Inoue1) and Tatsuya Fujii1)
1)Department of Pediatrics, Shiga Medical Center for Children
2)Department of Health Science, Faculty of Medical Sciences, University of Fukui
Abstract
Long-term administration of an antibiotic containing pivalic acid causes secondary carnitine deficiency, but whether short-term treatment also exerts this effect remains unknown. Here, we describe a patient with secondary carnitine deficiency after low dietary intake and two days of treatment with an antibiotic containing pivalic acid. The patient was a 10-month old boy with severe pneumonia associated with respiratory syncytial virus infection who developed hypotonia after low dietary intake and two days of therapy with an antibiotic containing pivalic acid before admission. Laboratory findings upon admission showed a serum concentration of free carnitine of 11.0 (normal range: 36-74) μmol/L. Supplementation with L-carnitine (100 mg/day) normalized the free carnitine level and improved the hypotonia. The possibility of primary carnitine deficiency was excluded after terminating carnitine supplementation, and secondary carnitine deficiency was diagnosed. Low dietary intake can cause carnitine deficiency in children and even short-term administration of an antibiotic containing pivalic acid can further increase the risk. Carnitine supplementation should be considered when administering even a short course of such antibiotics to patients with a concurrent risk of carnitine deficiency such as low dietary intake.
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