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THE JOURNAL OF THE JAPAN PEDIATRIC SOCIETY
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Vol.129, No.1, January 2025
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Original Article
Title
A Study of the Impact of Shift Work for Neonatologists on Physicians' Work Measures
Author
Masahiko Murase Yuutaro Noguchi Gakuto Ujjie Hideyuki Asai Mio Igawa and Hirokazu Ikeda
Children's Medical Center, Showa University Northern Yokohama Hospital
Abstract
Background
The doctor's work style reform aims to ensure the work interval (WI) and restrict continuous working hours (CH) and overtime working hours (OH) from 2024. However, the contributing factors to shift work in the neonatal field on WI, CH, and OH have not been determined.
Objective
This study aims to determine the influence of WI, CH, and OH on neonatologists' shift work.
Methods
We retrospectively collected neonatologists' working data from April 2021 to March 2022 and divided the physicians into resident and staff who received and completed a special postgraduate program, respectively. The number of doctors involved, administration number per month, monthly occupancy rate of the neonatal intensive care unit (NICU) and growth care unit (GCU), and resident/staff number were collected as the affecting factors.
Results
The median number of failures per person for CH and WI were 0 and 1 per month, respectively. Ninety-four percent of WI failures were associated with night shifts. The OH was found to be 39.3 hours per month. The group of WI failure had a significantly higher monthly occupancy rate of NICU than the group of WI compliance (p<0.01). Moreover, the exceeded OH group had a higher monthly occupancy rate of GCU than the within OH group.
Discussion
WI is associated with the monthly occupancy rate of the NICU. Furthermore, OH was associated with resident, the number of physicians, and the monthly occupancy rate of GCU.
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Original Article
Title
Usefulness of Infant RPR/Mother RPR (Automated Method) Ratio and Infant Serum IgM Level in the Diagnosis of Congenital Syphilis
Author
Hiroyuki Shimizu1) Ryoko Higa2) Yoshinori Nagahara2) Kiyotaka Edamatsu3) Tomoko Kawada3) and Masaaki Mori4)5)
1)Department of Clinical Laboratory Medicine, Fujisawa City Hospital
2)Department of Infection Prevention and Control, Yokohama City University Medical Center
3)Department of Clinical Laboratory, Fujisawa City Hospital
4)Division of Rheumatology and Allergology, Department of Internal Medicine, St. Marianna University School of Medicine
5)Department of Lifelong Immunotherapy, Institute of Science Tokyo
Abstract
Congenital syphilis is a preventable perinatal infection if treated appropriately; thus, the early detection and treatment of this condition is extremely important. In order to provide appropriate treatment for infants born to pregnant women infected with syphilis, foreign guidelines recommend comparison of the non-treponemal lipid antibody (RPR; rapid plasma reagin) levels of the mother and infant. When the RPR level of the infant is four times greater than the mother's RPR level by the multiple dilution method, the probability of congenital syphilis is judged to be high. However, an automated method that can measure values more precisely has recently been used in Japan. We compared the RPR ratios of the infant and mother in 18 pregnant women with syphilis, two of whom were infected with syphilis, and found that the ratios were 1.0 and 1.4 times. Alternatively, the RPR levels of all 16 non-infected infants were lower than that of mothers. Among previously reported cases of congenital syphilis in Japan, the RPR ratios were significantly different between the two groups, but the median value did not exceed 1 even in cases of confirmed congenital syphilis. A ratio greater than 1 indicates a high probability of congenital syphilis, however congenital syphilis cannot be ruled out even if the infant RPR level is lower than the maternal RPR level. In addition, there was a significant difference in serum IgM between the two groups, and this difference was considered useful for the diagnosis of congenital syphilis.
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Original Article
Title
Current Status of Pediatric Obstructive Sleep Apnea Management in Japan
Author
Osamu Higuchi1) Masatoshi Wakatsuki2) Chikako Motomura2) Takehide Imai3) Junichiro Tezuka4) Tomoki Nishikido5) Yosuke Yamada6) Yuichi Adachi7) and Takeshi Sugiyama8)
1)Department of Pediatrics, Kouseiren Takaoka Hospital
2)Department of Pediatrics, National Hospital Organization Fukuoka National Hospital
3)Yamaguchi Pediatric Clinic
4)Department of Allergy and Pulmonology, Fukuoka National Hospital
5)Department of Allergy and Pulmonology, Osaka Women's and Children's Hospital
6)Department of Neonatology, Tokyo Women's Medical University Medical Center East
7)Department of Pediatrics, Faculty of Medicine, University of Toyama
8)Department of Pediatrics, Ichinomiya-Nishi Hospital
Abstract
Obstructive sleep apnea (OSA) is a prevalent condition in pediatric care. However, guidelines for the treatment of pediatric OSA have not yet been established in Japan. A national questionnaire survey was conducted from September to November 2021, targeting 472 individuals pediatric residency hospital representatives and 850 members of the Japanese Society of Pediatric Pulmonology via an online platform. Of the 1,322 individuals contacted, 340 responded (a response rate of 25.7%). After eliminating duplicate responses, we conducted an analysis on 178 general hospital responses.
Among hospitals, 91 (51.1%) reported providing care for children with suspected OSA, while 107 (60.1%) conducted pediatric sleep-breathing tests. Overnight continuous pulse oximetry and home sleep apnea tests were performed in 66 hospitals (37.1%), whereas polysomnography (PSG) was performed in 42 hospitals (23.6%).
The criteria for surgical indications for OSA with adenotonsillar hypertrophy (ATH) varied considerably among hospitals. Factors considered included sleep-breathing test outcomes, significant ATH, recurrent tonsillitis, otitis media, and videos during sleep, leading to a diverse and a comprehensive assessment. However, the average lower age limit for surgery stood at 3.05 years, displaying a spectrum of 0 to 6 years across different hospitals.
Disparities in the management of OSA among pediatricians highlighted significant gaps within healthcare environments across various hospitals, thereby indicating the need for dedicated guidelines.
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Case Report
Title
Complete Transposition of the Great Arteries with Kawasaki Disease (KD) Onset after the Jatene Procedure with Difficulties in Coronary Artery Evaluation
Author
Kosuke Furuya1) Satoko Suzuki1) Hiroshi Hataya1) Jun Maeda2) and Masaru Miura2)
1)Department of General Pediatrics, Tokyo Metropolitan Children's Medical Center
2)Department of Cardiology, Tokyo Metropolitan Children's Medical Center
Abstract
Thanks to improvement in the outcomes of the Jatene procedure, the long-term survival rate for complete transposition of the great arteries now exceeds 90%, and there are scattered reports of KD in the remote stage. Interpreting transthoracic echocardiographic findings of coronary artery lesions in KD may be difficult depending on the underlying disease. We report a 2-year-old, male patient who underwent the Jatene procedure for complete transposition of the great arteries type I, then contracted KD with all major symptoms on postoperative day 4. He had Kobayashi score 8, WBC 16,890/μL, neutrophils 87.4%, and CRP 29.1 mg/dL. Prednisolone 2 mg/kg/day, intravenous immunoglobulin 2 g/kg, and aspirin 30 mg/kg/day were immediately administered. On admission, echocardiography demonstrated a proximal right coronary artery diameter of 2.1 mm (Z-score+1.4). The diameter of the anterior descending branch of the left coronary artery was 1.7 mm (+0.4), but where the coronary artery had been grafted to the anterior coronary sinus was difficult to identify. The patient responded well to the treatment, after which no coronary artery lesions were observed. The origin of the anterior coronary artery was still difficult to visualize by ultrasound on days 35 and 70, but no coronary artery lesion was found.
Data on the postoperative coronary artery diameter trends were insufficient, and whether the Z-score was appropriate for evaluating the patient during the disease course was unclear. To avoid coronary artery stenosis and occlusion in the remote period, careful acute management is desirable to prevent coronary artery aneurysm formation.
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Case Report
Title
Trisomy 18 Exhibiting Short-term Hypoxemia after Pulmonary Artery Banding
Author
Toshikazu Hayashiya1) Toshikatsu Tanaka1) Hiroki Inase1) Chie Iida1) Yukiho Hirota1) Yasunobu Miki1) Shingo Kubo1) Michio Matsuoka1) Naoya Kamei1) Yoshiharu Ogawa1) Akiko Tamura2) and Sachiko Kido1)
1)Department of Cardiology, Hyogo Prefectural Kobe Children's Hospital
2)Department of Pediatrics, Tottori Prefectural Central Hospital
Abstract
We present a case of a trisomy 18 patient with ventricular septal defects developed hypoxemia shortly after pulmonary artery banding. The patient was a 9-month-old male infant diagnosed with trisomy 18, ventricular septal defect, and patent ductus arteriosus after birth. Pulmonary artery banding was performed at 2 months of age, and hypoxemia developed 3 months postprocedure. Echocardiography and pulmonary angiography revealed that the thickened pulmonary valve leaflet fitted into the banding segment during systole, which was presumed to have caused reduced pulmonary blood flow and hypoxemia. At 9 months of age, the pulmonary artery banding was released and the ventricular septal defect was closed. The hypoxemia resolved, and the patient was discharged 4 months after the surgery. The elongated leaflet of the pulmonary artery valve, a characteristic of trisomy 18, overlapped with the banding segment, intensifying the shear stress on the valve leaflet, and led to a thickening of the leaflet intima within a short period. The thickened valve leaflet was presumed to fit into the banding segment, reducing pulmonary blood flow. Although palliative surgery for trisomy 18 improves prognosis and facilitates discharge, preoperative evaluation based on anatomic features is crucial. In the case of pulmonary artery banding, assessing the length and properties of the valve leaflet is advisable.
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Case Report
Title
Anti-NXP2-antibody Positive Juvenile Dermatomyositis Complicating Intractable Multiple Oral Ulcers
Author
Hitoshi Irabu1) Asami Shimbo1) Susumu Yamazaki2)3) Chihiro Nemoto4) Ryugo Hiramoto4) Masaaki Mori2) and Masaki Shimizu1)
1)Department of Pediatrics and Developmental Biology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University
2)Department of Lifetime Clinical Immunology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University
3)Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine
4)Department of Pediatrics, Children's Medical Center, Matsudo City General Hospital
Abstract
Anti-nuclear matrix protein 2 (NXP2) antibody-positive juvenile dermatomyositis (JDM) is clinically characterized with severe muscle weakness and gastrointestinal lesions and often requires aggressive anti-inflammatory treatments. Here, we report a case of a female patient with anti-NXP2 antibody positive JDM who presented with intractable multiple oral ulcers. A 14-year-old adolescent girl presented with muscle pain of both upper limbs and lower back, muscle weakness and skin. She was diagnosed with anti-NXP2 antibody positive JDM. She was treated with a combination of prednisolone (PSL) and methotrexate and remission was achieved. However, her disease relapsed during PSL taper. She was referred to us with intractable multiple oral ulcers in addition to marked muscle weakness with dysphagia and severe vascular edema of lower legs. She was treated with a combination of methylprednisolone pulse therapy, intravenous immunoglobulins, tacrolimus and hydroxychloroquine. Remission was achieved one month after starting combination treatments, although gastrointestinal bleeding was observed during her clinical course. She is in drug-free complete remission now, three years later. Although oral ulcers are uncommon, they should be considered in patients with JDM. Anti-NXP2 antibody-positive JDM is often associated with severe JDM pathology. Early diagnosis and proper therapeutic intervention are essential. Anti-NXP2 antibody is detected in approximately 30% of JDM patients. It is desirable to establish a measurement system and insurance coverage for anti-NXP2 antibodies.
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Brief Report
Title
Nationwide Survey for Acute Flaccid Paralysis in Japan, 2019―2022
Author
Itsumi Toyokura1) Takako Sano1) Jun-ichi Sakuragi1) Pin Fee Chong2) Harushi Mori3) Hiroyuki Torisu4) Akihisa Okumura5) Ryutaro Kira6) and Keiko Tanaka-Taya1)
1)Kanagawa Prefectural Institute of Public Health
2)Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University
3)Department of Radiology, Jichi Medical University
4)Section of Pediatrics, Department of Medicine, Fukuoka Dental College
5)Department of Pediatrics, Aichi Medical University School of Medicine
6)Department of Pediatric Neurology, Fukuoka Children's Hospital
Abstract
Acute flaccid paralysis (AFP) is a category 5 infectious disease under the Act on the Prevention of Infectious Diseases and Medical Care for Patients with Infectious Diseases (the Infectious Diseases Control Law). AFP cases under 15 years of age must be notified to a public health center within 7 days of diagnosis.
A survey was conducted among child neurologists registered by the Japanese Society of Child Neurology to grasp the situation of AFP cases nationwide from 2019 to 2022. A total of 145 AFP cases were reported, of which 137 were eligible for notification, however, only 41 (30%) were reported to public health centers. The survey results suggest that physicians may not have sufficient awareness regarding the necessity of notification to public health centers for the disease. For prompt detection and response to AFP, it is desirable to continue promoting awareness of the reporting requirements for this disease.
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