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THE JOURNAL OF THE JAPAN PEDIATRIC SOCIETY
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Vol.127, No.12, December 2023
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Original Article
Title
Real-world Survey on Prescriptions for Propranolol in Patients with Pediatric and Congenital Heart Diseases
Author
Kouji Higashi1) Masaru Miura2) Hiroshi Ono3) Heima Sakaguchi4) Masayoshi Nakakuni5) and Kosuke Nakano5)
1)Department of Cardiology, Chiba Children's Hospital
2)Department of Cardiology, Tokyo Metropolitan Children's Medical Center
3)Department of Cardiology, National Center for Child Health and Development
4)Departments of Pediatric Cardiology, National Cerebral and Cardiovascular Center
5)Department of Multicenter Collaboration, Network Promotion Unit, Clinical Research Center, National Center for Child Health and Development
Abstract
Background: Propranolol is a beta-blocker which is used to treat many pediatric cardiovascular diseases. However, the tablet is the only applicable dosage form for pediatric patients, and patients who cannot take tablets have to crush them. Objective: To clarify problems of propranolol prescription for pediatric patients with cardiovascular disease. Study design: A cohort study using Pediatric Medical Information Collection System from children's hospitals and pediatric clinics. Methods: Clinical medical data from 2,151 patients less than 15 years of age who had been prescribed propranolol between April 2016 and March 2021 were analyzed. Results: Of the 2,151 patients, 1,833 patients were eligible for propranolol, of which 1,222 were patients of pediatric cardiovascular disease. The median age at the time of first prescription was 5 months old. There were 241 patients who were less than 1 month old (19.7%), 504 patients who were 1 month old or older but less than 1 year old (41.2%), 238 patients who were 1 year old or older but less than 7 years old (19.5%), and 239 patients who were 7 years old or older but less than 15 years old (19.6%). The total number of prescriptions was 13,085, of which 11,743 (89.7%) were tablets. There were 909 patients (78.9%) who were prescribed crushed tablets, and the number of prescriptions was 9,676 (82.4%). The median daily dose of crushed tablets was 8.0 mg/day (interquartile range 3.0−15.0 mg/day). Conclusion: We were able to clarify that there is indeed a lack of dosage form for propranolol for pediatric patients with cardiovascular diseases. We strongly anticipate the development of suitable dosage forms according to age.
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Original Article
Title
The Effects of Levothyroxine Sodium Hydrate Replacement Therapy on the Growth Rate of Central Congenital Hypothyroidism
Author
Takeshi Goda1) Kei Hirayama1) Go Horiguchi2) Jun Mori3) and Akio Kihara1)
1)Department of Pediatrics, Kyoto Chubu Medical Center
2)Graduate School of Medicine, Biometrics, Kyoto Prefectural University of Medicine
3)Department of Pediatrics, Kyoto Prefectural University of Medicine
Abstract
The diagnosis of central congenital hypothyroidism (CCH) is often led by clinical symptoms, such as growth failure. CCH is treated with levothyroxine sodium hydrate (LT4), but there have been a few reports on its effect of improving the growth rate. The purpose of this retrospective study was to evaluate the effects of LT4 replacement therapy on the growth rate of CCH complicated with growth failure. In our study, we analyzed 5 CCH patients with LT4 replacement therapy alone. After 3 months of LT4 replacement therapy, their mean growth rate SD score (±SD) increased from -3.63 (±1.84) to+10.6 (±11.2) in 3 out of 5 patients. The result suggests that the efficacy of LT4 replacement therapy against CCH complicated with growth failure can be estimated in a period of 3 months. Therefore, if catch-up growth cannot be provided after 3 months of LT4 replacement therapy, additional examination and treatment should be considered to rule out other conditions, such as growth hormone deficiency or malnutrition.
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Original Article
Title
Regional Real-world Clinical Study of BNT162b2 Vaccine Effectiveness against Omicron in Children Aged 5 to 11 Years
Author
Fujio Kakuya1) Hikaru Onoda1) Hitoshi Okubo1) Hiroaki Fujiyasu1) Fumie Inyaku1) and Takahiro Kinebuchi2)
1)Department of Pediatrics, Furano Hospital
2)Department of Clinical Laboratory, Furano Hospital
Abstract
We estimated the BNT162b2 vaccine effectiveness (VE) against coronavirus disease 2019 (COVID-19) with symptoms in children aged 5-11 years during the "Omicron variant dominant"period in Furano, Japan in 2022.
Among all 335 children, the adjusted VE was 63% (95% confidence interval [CI], 36 to 79) after one or two doses (n=115) and 66% (95% CI, 28 to 83) after fully-vaccinated doses (n=73). After one or two doses of vaccination, the adjusted VE was 31% (95% CI, -102−76) at 5−6 years (n=22), 72% (95% CI, 23−90) at 7−8 years (n=41), 79% (95% CI, 43−92) at 9−11 years (n=52), 68% (95% CI, 41−83) at 12-20 weeks (n=67) and 57% (95% CI, -22−85) at 21−27 weeks (n=48). Similarly, after fully-vaccinated doses, the adjusted VE was 15% (95% CI, -246−79) at 5−6 years (n=13), 85% (95% CI, 20−97) at 7−8 years (n=26), 79% (95% CI, 24−94) at 9−11 years (n=34), 68% (95% CI, 41−83) at 12−20 weeks (n=26) and 57% (95% CI, -22−85) at 21-27 weeks (n=47).
The BNT162b2 showed statistically significant VE against PCR-confirmed COVID-19 with symptoms among children aged 5-11 years. However, the VE reduced over time.
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Case Report
Title
Management of Anomalous Aortic Origin of Coronary Artery: A Review of 7 Cases
Author
Yutaka Hatano1) Daichi Fukumi1) Sayaka Mii1) Kazuki Matsumoto2) Naoki Ohashi3) and Hajime Sakurai4)
1)Department of Pediatrics, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital
2)Department of Pediatrics, Nagoya Ekisaikai Hospital
3)Department of Pediatric Cardiology, Japan Community Health care Organization Chukyo Hospital
4)Department of Cardiovascular Surgery, Japan Community Health care Organization Chukyo Hospital
Abstract
Congenital coronary artery anomalies are a common cause of sudden cardiac death in children. However, the clinical course and outcome are unknown. We retrospectively reviewed 7 cases of children under 15 years old (median age: 8.5 years old, male/female ratio: 3: 1) who were diagnosed with single coronary artery or anomalous aortic origin of coronary artery between January 2012 and February 2021, based on medical records. One patient had a right single coronary artery, and 4 patients (median age: 13 years old, male/female ratio: 3: 1) had an anomalous aortic origin of the left main coronary artery (AAOLCA) with the left coronary artery located between the aorta and pulmonary artery. Three of these 5 children (median age: 13 years old, male: female ratio: 2: 1) were symptomatic, with symptom resolution achieved in all 3 after surgery. The two remaining asymptomatic patients also underwent surgery. The other two patients were asymptomatic and did not undergo surgery in the left single coronary artery. In children with right single coronary artery and AAOLCA with the left coronary artery running between the aorta and pulmonary artery, surgical intervention should be considered because of subclinical myocardial ischemia.
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Case Report
Title
A Case of an Infant with Midgut Volvulus Mimicking Food Protein-induced Enterocolitis Syndrome Presenting as Chronic Vomiting
Author
Takuya Wada1) Yuichi Adachi2) Takaharu Nishijima3) and Sachiko Nakaoka4)
1)Department of Pediatrics, Toyama City Hospital
2)Pediatric Allergy Center, Toyama Red Cross Hospital
3)Department of Pediatrics, Kurobe City Hospital
4)Department of Pediatrics, Toyama Red Cross Hospital
Abstract
In the diagnosis of food protein-induced enterocolitis syndrome (FPIES), it is important to exclude infectious diseases, gastrointestinal surgical diseases, intracranial diseases, and other differential diagnoses.
A one-month-old infant presented to our hospital for the first time with bilious vomiting. Abdominal ultrasonography showed no abnormality. Vomiting resolved with fasting and flared up with breastfeeding. A hydrolyzed formula was administered with the resolution of symptoms. An allergen-specific lymphocyte stimulation test (ALST) for lactoferrin was positive. Thus, he was diagnosed with FPIES caused by cow's milk.
However, he continued to vomit once a week and had poor weight gain. Abdominal ultrasonography revealed a "whirlpool sign," at the time of symptomatic presentation, depicting the small intestine and superior mesenteric vein in a spiral shape. A diagnosis of midgut volvulus was given.
This case highlights the importance of excluding differential diagnoses. If symptoms persist despite basic treatment for FPIES, it is important to reevaluate the differential diagnoses.
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Case Report
Title
A Pediatric Case with Severe Motor and Intellectual Disabilities Treated with Tolvaptan for Hyponatremia Caused by SIADH
Author
Kanako Gima Shogo Minamikawa Yukari Aida Kengo Nakashima Yusuke Ishida Mao Mizuta and Yasuo Nakagishi
Department of General Pediatrics, Hyogo Prefectural Kobe Children's Hospital
Abstract
Recently, tolvaptan was approved by the regulatory authorities for the treatment of hyponatremia caused by syndrome of inappropriate antidiuretic hormone secretion (SIADH). However, there have been few reports of its use, its therapeutic efficacy, adverse events, and appropriate dosage in pediatric patients. In this report, we describe the treatment with tolvaptan for refractory hyponatremia which is thought to be caused by SIADH in a child with severe mental and physical disabilities. We report a 2-year-old boy with severe motor and intellectual disabilities, and syndrome of inappropriate secretion of antidiuretic hormone (SIADH). He was treated for chronic hyponatremia with fluid restriction and NaCl medication. After a change of enteral nutrition, he developed diarrhea and was hospitalized for hypertonic dehydration. After correction of the hypernatremia, he developed an upper respiratory tract infection and his serum Na level dropped to 114 mEq/L. He had fluid restriction and NaCl loading again but the serum Na level was little improvement. Therefore, we started the treatment with a single dose of tolvaptan 0.15 mg/kg. After administration of tolvaptan, the patient's urinary output increased rapidly, Na concentration jumped up to 141 mEq/L the next day. We stopped using tolvaptan and injected water through a gastrostomy tube. We then adjusted the dose, his hyponatremia improved with a dose of 0.15 mg/kg/day, the same as the initial dose, and he was discharged. There have been many reports of sodium overcorrection with tolvaptan. Risk factors for Na overcorrection in this case is as follows: the lack of information about an initial dose of tolvaptan in the child with SIADH, low serum Na levels prior to administration, and severely handicapped child unable to complain of thirst. Careful observation is essential to avoid rapid Na correction, especially in children with high risk for Na overcorrection due to tolvaptan.
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