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THE JOURNAL OF THE JAPAN PEDIATRIC SOCIETY
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Vol.123, No.3, March 2019
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Review
Title
Neonatal Screening for Critical Congenital Heart Disease with Pulse-oximetry
Author
Hiroshi Ono1) Taiyu Hayashi1) Hitoshi Kato1) and Akira Oka2)
1)Division of Cardiology, National Center for Child Health and Development
2)Department of Pediatrics, University of Tokyo
Abstract
Critical congenital heart diseases (CCHD) are associated with suboptimal prognosis and early detection results with a better clinical outcome. Neonatal screening for CCHD with pulse-oximetry is being performed worldwide, and there are plenty of reports on the effectiveness of the screening programs. However, no such screening program has been implemented in Japan. Furthermore, few reports on pulse-oximetry screening have been published in Japan. Although we focus on fetal echocardiography and post-neonatal physical examinations as means of screening for CCHD, the diagnostic yield still remains insufficient. The neonatal screening program for CCHD with pulse-oximetry, unlike fetal echocardiography, requires no specific skills and has high specificity as well as a high cost-effectiveness ratio. The neonatal screening program for CCHD with pulse-oximetry should be established by pediatric and obstetric guideline development in Japan.
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Original Article
Title
Effect of the Introduction of Rotavirus Vaccine for Decrease of Rotavirus Gastroenteritis Outpatient Visits and Hospitalizations
Author
Toshihiko Mori1) Ikumi Yabuki1) Emiko Hoshino1) Satoshi Hirakawa1) Nodoka Sakurai1) Yuki Kuroiwa1) Shigeto Fuse1) and Hiroyuki Tsutsumi2)
1)Department of Pediatrics, NTT East Sapporo Hospital
2)Department of Pediatrics, Sapporo Medical University School of Medicine
Abstract
We investigated the positive rate of rotavirus (RV) rapid test, the number of RV positive results (annual average), the number of RV gastroenteritis hospitalizations (annual average), and the proportion of RV gastroenteritis hospitalizations among all acute gastroenteritis hospitalizations during pre-vaccination (2006-2011) and post-vaccination periods (2012-2017). The post-vaccination period was divided into three phases every two years (phase I: 2012-2013, phase II: 2014-2015, phase III: 2016-2017). The estimated vaccination rate of RV vaccine in Sapporo increased from 34.6% in 2012 to 68.4% in 2017. From phase I, the rapid test positive rate of RV and positive number of RV decreased to 67% (p<0.001) and 65%, respectively, compared to the pre-vaccination period. The number of RV gastroenteritis hospitalizations and the proportion of RV gastroenteritis hospitalizations among all acute gastroenteritis hospitalizations decreased in phase II and III; 69% and 69% (p<0.001), respectively, in phase II, and 42% (p<0.05) and 43% (p<0.001) in phase III, respectively, compared to the pre-vaccination period. The increase in the presumed vaccination rate in Sapporo has become very slow after 2015. The introduction of RV vaccine in the National Immunization Program in Japan is necessary to dramatically improve the vaccination coverage rate, and its early realization is desired.
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Original Article
Title
A Retrospective Study of 166 Acute Poisoning Cases at a Pediatric Emergency Department in Japan
Author
Mariko Terauchi Osamu Nomura Kentaro Iwata Shun Kishibe Hirokazu Takei and Yusuke Hagiwara
Division of Pediatric Emergency Medicine, Tokyo Metropolitan Children's Medical Center
Abstract
Background
Accidental ingestion of medications is a common problem in pediatric emergency medicine. However, there are few reports in Japan describing the acute poisoning of children.
Methods
We conducted a retrospective descriptive study at Tokyo Metropolitan Children's Hospital. Patients who visited our pediatric emergency department with acute poisoning between March 2010 and June 2016 were included. Of 313 eligible patients, 166 were analyzed after excluding 75 patients with intentional ingestion, 27 patients with non-medication ingestion, and 45 patients with insufficient data or no obvious evidence of ingestion.
Results
The mean age of the patients was 2 years; 92% (152 cases) of the patients were younger than 5 years, and 95% (158 cases) of ingestions occurred at home. Cold remedies or antitussive drugs (33 cases), minor or major tranquilizers (26 cases), and antihistamines (24 cases) were most commonly ingested. Gastrointestinal decontamination was performed in 19 cases. Of 50 (30%) hospitalized patients, 26 showed symptoms of poisoning such as neurological symptoms, but all patients were favorably discharged.
Conclusion
Among the pediatric patients who visited our emergency department, about 30% required hospitalization and 10% required decontamination. Careful history-taking for ingestions enables appropriate diagnosis and decision-making in the treatment of children visiting the emergency department for an accidental ingestion of medication.
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Case Report
Title
A Case of Terile Transient Neonatal Pustulosis with Multiple Vesiculopustules at Birth
Author
Tamaki Ueda Norihiko Uchida Shiho Kodama and Megumi Takemoto
Department of Pediatrics, Hamanomachi Hospital
Abstract
Pustules in the newborn may be caused by infections, congenital disorders, or other diseases. Benign and self-limited disorders, including erythema toxicum neonatorum (ETN), transient neonatal pustular melanosis (TNPM), do not require specific therapy. TNPM is an uncommon vesiculopustular rash characterized by small pustules on a non-erythematous base, noted at birth or during the first day of life. The lesions rupture spontaneously, leaving pigmented macules that usually fade with few weeks. However, a clear-cut differentiation between ETN and TNPM is not always possible, and it has been suggested that the name sterile transient neonatal pustulosis (STNP) explains such overlapping conditions. We report a full-term male neonate with multiple vesiculopustular at birth and pigmented macular lesions. The culture of the pustules was negative, and a Wright-stained smear of pustule contents showed numerous neutrophils. However histological examination of a biopsy showed eosinophils. Pustules disappeared at 10 days of age, only about 3 weeks after birth left mild pigmentation. We diagnosed this case as STNP. When pustules are seen at birth, it is important to distinguish STNP as well as severe infections such as neonatal herpes and septicemia.
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Case Report
Title
Electromagnetic Interference in a 4-years-old Girl with a Cardiac Resynchronization Therapy Implantable Cardioverter Defibrillator
Author
Masato Kimura Eichiro Kawai Chiharu Ota and Shigeo Kure
Department of Pediatrics, Tohoku University School of Medicine
Abstract
We report a 4-years-old girl with a cardiac resynchronization therapy implantable cardioverter defibrillator (CRT-D) in whom electromagnetic interference (EMI) occurred. The patient suffered cardiopulmonary arrest at 5 months of age and received an implantable cardioverter defibrillator (ICD) at age 7 months. The CRT-D was upgraded at the 10-month follow-up due to progressive heart failure and right ventricular pacing. Since replacement of the CRT-D, the patient has received no defibrillation or cardioversion. Her CRT-D functioned appropriately at the regular follow-up visits and during remote monitoring. EMI was detected during regular remote monitoring of the CRT-D at 1-month intervals. Intracardiac electrograms also revealed high-frequency signals suggestive of EMI. Her parents revealed that she received EMI at a game center. Her parents were instructed to ensure she avoids EMI in her daily life.
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Case Report
Title
Shock in the Setting of Acute Renal Failure Due to Bilateral Obstructed Megaureters in the Neonatal Period
Author
Yuto Arai1) Yoshinobu Nagaoka2) Tomohiro Nawa1) Motoki Takamuro1) and Masato Yokozawa1)
1)Department of Pediatric Cardiology, Hokkaido Medical Center for Child Health and Rehabilitation
2)Department of Pediatrics, Sapporo Medical University School of Medicine
Abstract
A 15-day-old, full-term boy with a history of several days of vomiting, anuria and lethargy was referred to our hospital.
He was in hemodynamic shock on arrival. Ultrasound of the heart and abdomen showed hypokinesis of the left ventricle and bilateral massive hydronephrosis with megaureters. Blood tests revealed acute renal failure and hyperkalemia, he was intubated, admitted to the intensive care unit and peritoneal dialysis was initiated. Left ventricular systolic function improved with correction of his potassium and acidosis, however the megaureters and renal function did not. A cystoscopy as well as voiding cystourethrography on day 19 confirmed bilaterally obstructed megaureters, and left percutaneous nephrostomy was performed. The right side was anatomically difficult and the procedure was aborted. After this, serum creatinine rapidly normalized and, surprisingly, the right hydronephrosis and megaureter also returned to normal within several days.
In this case, we hypothesize that newly formed urinary stones might have caused bilateral upper urinary tract obstruction. In an infant with recurrent vomiting and anuria, urinary tract anomaly should be considered.
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