|
THE JOURNAL OF THE JAPAN PEDIATRIC SOCIETY
|
Vol.127, No.9, September 2023
|
Original Article
Title
Impact of Coronavirus Infection 2019 on the Number of Inpatients and Hospitalization Revenue at a Regional General Hospital Pediatric Department
Author
Kazunori Tagami1) Shiro Sugiura3) Chihiro Tano1) Yuusuke Shibata1) Shunsuke Kato1) Toru Maeda1) Joon Nakata2) Takae Kobayashi2) Takenori Adachi1) and Takashi Kawabe1)
1)Department of Pediatrics, Kasugai Municipal Hospital
2)Department of Pediatric Allergy, Kasugai Municipal Hospital
3)Department of Child Health, Aichi Children's Health and Medical Center
Abstract
The coronavirus disease-2019 (COVID-19) pandemic has significantly impacted the management of hospitalized pediatric patients. This study aimed to evaluate the effects of the COVID-19 pandemic on the pediatric department of the Kasugai Municipal Hospital, a regional hospital without neonatal intensive care unit beds, and to determine the role of pediatric departments of regional general hospitals.
The number of inpatients and hospitalization revenue in our pediatric department in 2020 and 2021, as well as those per diagnosis procedure combination (DPC), were compared to the three-year average for 2017−2019. The number of inpatients largely decreased in both years. This resulted in a reduction in the number of pediatric beds (from 40 to 30). While managing beds was challenging during the respiratory syncytial virus outbreak in July 2021, the number of admissions for infectious diseases was lower than the previous three-year average. However, there was no significant change in the number of admissions for non-infectious diseases.
Compared to the hospital as a whole, there was a large decrease in hospitalization revenue for the pediatrics department. In addition, there was a large decrease in hospitalization revenue for infectious diseases, while that for non-infectious diseases was less drastic.
The structure of disease in hospital pediatrics has changed. Specialized chronic disease care was initially essential to secure a stable number of patients and revenue. However, responding to acute infectious disease outbreaks is also essential. Therefore, the department should have the capacity to adapt to new situations.
|
|
Case Report
Title
Neonatal Meningitis Due to Proteus mirabilis Complicated by Cerebral Infarction
Author
Yuka Shiraishi1) Yusuke Hoshino1) Junichi Arai1) Sho Ishii2) Yoshiya Yukitake1) Daigo Kajikawa1) Ayako Hinata1) and Rena Fuchino1)
1)Department of Neonatology, Ibaraki Children's Hospital
2)Department of Pediatric Infectious Diseases, Ibaraki Children's Hospital
Abstract
Proteus mirabilis is a gram-negative rod, that is part of the normal human intestinal flora, which can cause urinary tract, wound, and opportunistic infections in patients with an impaired immune system. P. mirabilis is an uncommon infectious organism involved in neonatal meningitis, the clinical presentation of which is not well known, with cerebral abscesses being the most frequently associated complication. Herein, we report a case of neonatal meningitis caused by P. mirabilis complicated by cerebral infarction.
The female patient was born at 39 weeks of gestation, and weighed 3,218 grams. She was admitted to our hospital three days after birth with a fever of 39.2°C. Spinal fluid investigations suggested bacterial meningitis, and treatment with ampicillin, cefotaxime, and gentamicin was initiated. Subsequently, P. mirabilis was detected in blood and cerebrospinal fluid cultures, which was determined to be the causative organism. Computed tomography scan of the brain on day 4 showed a hypointense area in the left cerebral hemisphere, and magnetic resonance imaging on day 19 showed an infarction in the same area. The fever resolved on day 4, and the child was discharged from the hospital on day 32 after 21 days of antimicrobial therapy. Follow-up examination at one year and six months of age was normal, with no obvious neurological sequelae.
Neonatal meningitis caused by P. mirabilis has high frequencies of intracranial complications; therefore, investigations with cranial imaging is important for delineating the pathogenesis, and determining treatment strategy.
|
|
Case Report
Title
A Case of Premature Neonate with Suppurative Submandibular Sialadenitis in Whom MRI Was Effective for Diagnosis
Author
Syunsuke Nagara Emi Tannaka Shinji Usui Miwa Kawashiri and Atsushi Yamagishi
Department of Pediatrics, Takayama Red Cross Hospital
Abstract
Neonatal suppurative submandibular sialadenitis, caused by bacterial infection from the oral cavity leading to inflammation of the submandibular gland, is characterized by purulent discharge from Wharton's canal due to compression of the gland, and is important for clinical diagnosis. In this case, we neglected to confirm discharge of pus from Wharton's canal due to compression of the submandibular gland, but neonatal suppurative submandibular sialadenitis was diagnosed based on redness and tenderness at the infected site, effectiveness of antibiotics, MRI findings, and exclusion of differential diseases. The reason for not confirming discharge of pus to reach a definitive diagnosis was due to our lack of awareness of this disease. However, since the purpose of the treatment was to prevent abscess formation and sepsis, the diagnosis of suppurative submandibular sialadenitis neonatal by MRI and prompt treatment seemed to be effective.
|
|
Case Report
Title
A Successful Case of Intravenous Immunoglobulin Administration for Intestinal IgA Vasculitis with Wound Infection
Author
Mirei Hoshino Yoshihiko Takano Nobuhiro Kawakami Kyoko Takayanagi Akira Iriyama and Takayuki Okamura
Department of Pediatrics, Sakai City Medical Center
Abstract
Intestinal IgA vasculitis is frequently treated with corticosteroids. We occasionally encounter refractory cases of repeated abdominal pain while tapering corticosteroids. We describe a case of refractory IgA vasculitis with wound infection that was successfully treated with intravenous immunoglobulin (IVIG) administration.
A seven-year-old boy was admitted with abdominal pain. He experienced recurrent abdominal pain while tapering corticosteroids and presented with severely itching purpura, hemorrhagic bullae, and ulceration associated with methicillin-resistant Staphylococcus aureus (MRSA) infection.
Human blood coagulation factor XIII fraction had no effect, but after IVIG administration, the patient achieved complete remission.
In Japan, IVIG efficacy in IgA vasculitis is rarely reported. We verified 23 nationwide case reports. Hence, IVIG can be an effective alternative treatment for refractory IgA vasculitis cases that are resistant to corticosteroids.
|
|
|
Back number
|
|
