Akihisa Nitta

Diastolic flow velocity of the left pulmonary artery of patent ductus arteriosus in preterm infants

Abstract Background : The usefulness of diastolic pulmonary flow velocity determined by echocardiography in the assessment of symptomatic patent ductus arteriosus (sPDA) in preterm infants has not been confirmed.

Role of infection in the development of acquired subglottic stenosis in neonates with prolonged intubation

Abstract Objective: To examine whether clinically diagnosed infection correlates with subsequent development of subglottic stenosis in intubated neonates.

Cardiopulmonary Arrest on Arrival in an Infant due to Ruptured Hepatoblastoma

P rimary tumors of the liver account for approximately 1% of malignancies in children, with an annual incidence of 1.6 cases per million children in the United States. Between 50% and 60% of hepatic tumors in children are malignant, and >65% of these are hepatoblastomas. Hepatoblastoma occurs predominantly in children <3 years of age. A 7-month-old male infant was transferred to our hospital with cardiopulmonary arrest on arrival caused by a ruptured hepatoblastoma. He was born at 41 weeks’ gestation at 3155 g. At 4 months of age, he had developed healthy, and no abnormality was found at a routine health examination. He had fever and diarrhea approximately 5 hours before admission to our hospital; abdominal distension was not noted at this time. Thoracoabdominal radiographs showed abdominal distension (Figure, A). Post-mortem laboratory findings showed anemia (hemogulobin level, 8.1 g/dL) and a high level of alpha-fetoprotein (994 200 ng/mL). Although an autopsy was initially refused by the parents, we obtained permission for post-mortem imaging with computed tomography (CT). Whole body CT revealed multiple tumors in the lung and huge tumors with calcification

Thyroxine for transient hypothyroxinemia and cerebral palsy in extremely preterm infants

Background:  The relationship of thyroxine supplementation for transient hypothyroxinemia of prematurity to the incidence of cerebral palsy (CP) in infants <28 weeks of gestation is unclear.

Precocious Puberty Resulting from Congenital Hypothalamic Hamartoma: Persistent Darkened Areolae After Birth as the Hallmark of Estrogen Excess

C entral precocious puberty due to congenital hypothalamic hamartoma may cause isosexual precocity from early infancy. Failure to recognize the physical findings occasionally delays the diagnosis of the disease until the patient is more than 1 to 2 years old.14 This delay may reduce the patients potential for adult height because of remarkably advanced skeletal age that is induced by the bone-maturing action of estrogen.5-7 To emphasize the importance of early diagnosis of this disease, we present a patient in whom persistent darkened areolae from birth, a hallmark of estrogen excess, was overlooked.

Congenital left brachiocephalic vein and superior vena cava aneurysms in an infant: final update with autopsy findings.

o the Editor: We previously have described the case of an infant with ongenital left brachiocephalic vein and superior vena cava SVC) aneurysms in The Journal. Unfortunately, the patient ied of chronic respiratory failure at 22 months of age because tracheostomy could not be performed, and an autopsy was erformed. Results of a gross inspection revealed numerous collatral veins of various sizes, which branched from the aneuysms and connected to the esophageal varices. The dilated lood vessel that we initially described as an SVC aneurysm as actually found to be a right brachiocephalic vein underoing fusiform dilatation, and the SVC was not dilated. The eft brachiocephalic vein aneurysm was saccular and composed f numerous interconnected cystic lesions containing thrombi Figure 1). Examination of histologic sections revealed systemic roliferation of multilocular hemangiomatous tissue that pentrated into the submucosa and muscular layer of the esophgus and rectum (Figures 2). Immunohistochemical investiation results demonstrated that the endothelial cells of the emangioma were CD34-negative (Figure 3). The overall linicopathologic findings led to a diagnosis of angiomatosis f the venous type. Angiomatosis is a diffuse form of hemangioma that ffects a large segment of the body in a contiguous fashion, P ither by vertical extension to involve multiple tissue planes or y crossing muscle compartments to involve tissues of similar ypes. Vascular malformation, arteriovenous malformation, nd venous malformation have been used as synonyms for ngiomatosis. Our experience suggests that venous-type angiomatosis hould be included in the differential diagnosis when huge ediastinal masses are present at birth.

Congenital cystic periventricular leukomalacia in a small‐for‐gestational age full‐term infant

© 2008 Japan Pediatric Society The mother was 36 years old with a birth history of gravida two para 2. Fetal ultrasonography indicated mild ventriculomegaly from 22 weeks of gestation and intrauterine growth retardation from 28 weeks of gestation ( Fig. 1 ), with unexplained causes. The mother had gestational diabetes, which was being monitored without medication, and pre-natal infections including toxoplasma, rubella, herpes and cytomegalovirus infection during pregnancy, but these were ruled out as causes.

Fetal Bone Formation Is Decreased from Middle Pregnancy to Birth

Fetal bone development is a complex process that is regulated and maintained by minerals, hormones, and growth factors delivered from the mother via the placenta. Various biochemical markers of fetal bone development have been identified. However, many aspects of this process remain unclear. The aim of the study was to measure the activities of serum tartrate-resistant acid phosphatase type 5b (TRACP 5b) as a bone resorption marker and bone alkaline phosphatase (BAP) as a bone formation marker in preterm and term neonates, and to investigate fetal bone development in middle and late pregnancy. The study included 111 neonates (87 preterm and 24 term) born at Dokkyo Medical University Hospital. Neonates with illnesses and maternal diseases were excluded. Serum samples were collected within 3 hours after birth and stored at -80°C. Univariate and multivariate linear regression analyses were performed. The 111 neonates (median birth weight, 1,510 g) were born at a median of 31.3 weeks of gestation, and had TRACP 5b and BAP activities of 10.9 ± 4.0 U/L and 127.5 ± 49.2 U/L, respectively. TRACP 5b activity showed a tendency to be higher in term neonates, while BAP activity tended to be lower in term neonates. Importantly, TRACP 5b activity was positively correlated with gestational age and birth weight, and BAP activity was negatively correlated with gestational age, rate of born small-for-gestational-age neonates, and birth weight. These results suggest that bone formation during fetal growth is gradually decreased from middle pregnancy to birth, whereas bone resorption is gradually increased.