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THE JOURNAL OF THE JAPAN PEDIATRIC SOCIETY
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Vol.123, No.4, April 2019
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Original Article
Title
Clinical Features of Opportunistic Cytomegalovirus Infection after Pediatric Kidney Transplantation and Its Effects on Graft Function
Author
Hideki Ban Ken-ichiro Miura Kiyonobu Ishizuka Takaya Iida Yohei Taniguchi Takeshi Nagasawa Yoko Shirai Naoto Kaneko Tomoo Yabuuchi Yoko Takagi and Motoshi Hattori
Department of Pediatric Nephrology, Tokyo Women's Medical University
Abstract
Background: Opportunistic cytomegalovirus (CMV) infection after kidney transplantation is a major complication affecting graft and patient survival, and the international guidelines recommend prophylactic therapy with oral valganciclovir (VGCV) for high-risk (donor-seropositive/recipient-seronegative [D+/R−]) pediatric recipients. However, preemptive therapy with periodic antigenemia assay is routinely performed in Japan because VGCV is not covered by medical insurance and a dry syrup formula is not available.
Methods: Fifty-nine pediatric patients who received living-donor kidney transplantation and were managed with preemptive therapy at our hospital between January 2008 and December 2016 were retrospectively examined using medical records.
Results: CMV infection occurred in 21 of 59 (35.6%) patients overall and 12 of 16 D+/R− (75.0%) patients, respectively. CMV disease occurred in 10 of 59 (16.9%) patients overall and 9 of 16 (56.3%) D+/R− patients, respectively, showing a high incidence in D+/R− patients. The CMV-infected group had a significantly lower eGFR by one year after kidney transplant than the group not infected with CMV (p=0.025).
Conclusions: Our study demonstrated that CMV infection was a risk factor for diminished graft function, suggesting that prophylactic therapy be recommended for pediatric kidney transplantation.
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Original Article
Title
Pediatric In-hospital Resuscitation: A Retrospective Multicenter Survey
Author
Shunsuke Ogaya1) Atsushi Numaguchi1)2) Sachie Ito1) Kazunori Tagami1) Chihiro Abe-Hatano1) Yuko Miyachi1) Jun'ichi Kawada1) Jun Natsume1) Seiji Kojima1) and Yoshiyuki Takahashi1)
1)Department of Pediatrics, Nagoya University Graduate School of Medicine
2)Department of Emergency and Critical Care Medicine, Nagoya University Hospital
Abstract
We conducted a retrospective multicenter survey of critically ill children who required in-hospital resuscitation. Between 2010 and 2012, we identified 355 patients from the databases of 21 hospitals, and after excluding patients representing DNAR or patients who required out-of-hospital resuscitation, we finally identified 76 patients. Although 16 of 36 (44%) hospitals were equipped with an intensive care unit (ICU), no hospital had a pediatric intensive care unit (PICU). Forty-eight of 76 (63%) patients received resuscitation in a general ward and a delay of starting resuscitation by more than 5 minutes was observed in 5 of the 37 patients (14%) whose data we could collect in this group. The rate of return of spontaneous circulation was 55% (42 of 76 patients), which was inferior to data from previous reports in large hospitals equipped with a PICU. Our study implies the need for the centralization of critically ill children to improve the outcomes of those who require in-hospital resuscitation.
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Case Report
Title
A Case of Infective Endocarditis Caused by Bloodstream Infection Related with Peripheral Venous Catheter
Author
Toshiyuki Ito1) Maki Shimizu1) Kazuya Terada2) and Hiroko Kozan1)
1)Department of Pediatrics, Takamatsu Red Cross Hospital
2)Department of Pediatric Cardiology, Shikoku Medical Center for Children and Adults
Abstract
We report a case of infective endocarditis in a 3 year-old-girl without congenital heart disease. She was initially admitted to a previous hospital because of influenza A complicated with febrile convulsion, she was transferred to our hospital due to persistent fever. In our hospital, she had recurrent fever despite antibiotic treatment. Blood culture examination revealed Staphylococcus aureus. Cardiac ultrasonography revealed prolapse of the anterior leaflet of the tricuspid valve and vegetation on the leaflet. In addition, computed tomography of the chest showed multiple nodular lesions with feeding vessel signs in the lower lobes of both sides. Therefore a diagnosis of tricuspid infective endocarditis with septic pulmonary embolism on the basis of the Duke criteria was made. It was speculated that it was health care-associated infective endocarditis (HAIE) caused by bloodstream infection related to a peripheral venous catheter, because phlebitis of the puncture site by peripheral venous catheter was recognized during admission to the previous hospital. Although she was cured by antibiotic therapy, mild tricuspid regurgitation remained. We should recognize that HAIE can occur even in children without congenital heart disease, and peripheral venous catheters are important routes of infection.
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Case Report
Title
A Case of an Infant with Hemoglobinopathy Incidentally Found with Low SpO2 after the Alleviation of Asthma Exacerbation
Author
Yuya Morooka Go Yamamoto Kuniya Hatakeyama and Masaaki Hirata
Department of Pediatrics, Fukuoka Tokusyukai Hospital
Abstract
We report the case of an infant with low (90%-95%) arterial oxygen saturation by pulse oximetry (SpO2) in room air, despite improvement of respiratory distress following treatment for bronchial asthma exacerbation. Assuming the low SpO2 was a temporary phenomenon after the exacerbation, we did not consider the possibility of hemoglobinopathies. As a similar episode was again observed, the cause for the hypoxemia was investigated. No abnormalities were detected on the chest computed tomography scan or the echocardiogram. An arterial blood gas test revealed normal arterial partial pressure of oxygen (PaO2) and low arterial oxygen saturation (SaO2). Following genetic analysis, the patient was diagnosed with a low oxygen affinity hemoglobinopathy (Hemoglobin Presbyterian). In cases with unexpectedly low SpO2, discordant with the clinical presentation, it is important not to disregard low SpO2 levels, even those in the range of 90%-95%, and to perform an arterial blood gas test to exclude any hemoglobinopathies. If PaO2 is normal, hemoglobinopathies should be suspected and appropriate tests spares patients unnecessary medical investigations and treatments. Substantial understanding of hemoglobinopathies is required in the medical care of respiratory diseases including asthma, which offers opportunities for measuring SpO2 from infancy to evaluate respiratory failure.
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Case Report
Title
Multiseptate Gallbladder in a Child: Incidental Diagnosis on Ultrasonography
Author
Sachiko Fujii Satoshi Takamoto and Hiroshi Masuda
Masuda Children's Clinic
Abstract
A 4-year-old boy who had abdominal pain visited our clinic. Ultrasonography showed septations in the entire area within the gallbladder lumen. There were no findings of gallbladder wall thickening, bile duct dilatation or gallstones. Laboratory data were all within normal limits. Multiseptate gallbladder was diagnosed. Over observation for 6 months, no symptoms have appeared. Multiseptate gallbladder is a very rare congenital anomaly of the gallbladder in which only 13 child cases have been reported in the world. Our case is the first report of multiseptate gallbladder in a child in Japan. Here we report the case with some previously reported cases.
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