Akira Harigaya

Complications of peripherally inserted central venous catheter in Japanese neonatal intensive care units

The aim of this study was to investigate the incidence and risk factors of peripherally inserted central venous catheter (PICC)‐related complications using a multicenter case survey.

Effects of bathing immediately after birth on early neonatal adaptation and morbidity: A prospective randomized comparative study

Objective : Because the risks and benefits of early bathing of newborn infants are not well established, we investigated the effects of bathing immediately after birth on rectal temperature, respiratory rate, heart rate, blood pressure, percutaneous arterial blood oxygen saturation (SpO2) and early neonatal morbidity.

Role of Serum Leptin in the Regulation of Weight Gain in Early Infancy

We investigated the changes in the serum leptin concentration from birth to 30 days of age in order to determine the effects of leptin in early infancy. Twenty-seven Japanese term infants (12 boys and 15 girls) were examined. The serum leptin concentration at 3–6 days of age was significantly lower than that in cord blood (p < 0.0001) and was significantly higher at 30 days than at 3–6 days (p < 0.0001). The serum leptin concentration did not differ with gender or nutrition. The body weight gain and the magnitude of leptin rise that occurred between 3–6 and 30 days of age showed a significant positive correlation (r = 0.79; p < 0.0001). These changes in leptin levels suggest that leptin plays an important role in the regulation of weight gain in early infancy.

Transtubular potassium concentration gradient in preterm neonates

Abstract To determine the postnatal changes in mineralocorticoid action on the cortical distal nephron in preterm neonates, we evaluated the transtubular potassium gradient (TTKG) and its relationship to other renal and non-renal parameters in 16 preterm neonates during the first 5 weeks of life. Preterm neonates were divided into two groups according to their gestational age: the first group (group A, n=9) had a gestational age less than 30 weeks and the second group (group B, n=7) had a gestational age over 30 weeks. TTKG in both groups increased significantly with postnatal age, and TTKG in group A was significantly lower than that in group B (P=0.0003; two-way repeated analysis of variance). TTKG in group A was significantly lower during the 2 weeks of postnatal life than that in full-term neo- nates [TTKG during 1st week (mean±SD) 3.73±1.32, P<0.00001; during 2nd week 7.77±3.60, P=0.0096 versus full-term neonates (n=19); 11.56±3.23]. TTKG in group B was significantly lower only during the 1st week of life (6.55±2.71, P=0.0013) compared with full-term neonates. Plasma aldosterone concentration did not correlate with TTKG value. Stepwise regression analysis showed that postnatal age, cortical lumen sodium concentration (CLNa), and clinical condition requiring the use of mechanical ventilation were independent variables that correlated significantly with TTKG. We postulate that the low TTKG level in preterm neonates might reflect the prematurity of renal function (early postnatal age, CLNa) and the condition(s), relating to immaturity, such as the use of mechanical ventilation.

Treatment of Neonatal Infection Caused by Coxsackievirus B3

Four male infants with early neonatal infection caused by coxsackievirus B3 (presumed in one case) exhibited severe thrombocytopenia and liver dysfunction at presentation. The three infants who were administered human normal immunoglobulin within 3 days of disease onset survived, while the fourth infant, who received the preparation 6 days after disease onset, died.

Plasma thrombomodulin level in very low birthweight infants at birth

Objective: Plasma soluble thrombomodulin level reflects endothelial damage. The plasma thrombomodulin level at birth is increased in asphyxiated full‐term infants. There is no report of plasma thrombomodulin level in premature infants. To determine the thrombomodulin level in premature infants and whether it might reflect endothelial damage, we examined the plasma thrombomodulin level in very low birthweight (VLBW) infants at birth. Methods: Forty‐five VLBW infants, of whom 14 had perinatal asphyxia complications, were recruited. As a control, 50 full‐term infants wimout complications were also studied. Plasma thrombomodulin concentration, pH, base deficit, serum creatinine and D‐dimer concentration, platelet count and fibrinogen concentration were measured within 1 hour after birth. Results: There were significant differences in plasma pH, creatinine concentration, platelet count, antithrombin in activity and D‐dimer concentration between VLBW infants and full‐term infants. Plasma thrombomodulin concentration (39. 0 (16. 6–93. 7) vs 27. 0 (16. 6–39. 1) μg/L, p < 0. 0001) and plasma taombomodulin‐to‐serum creatinine ratio (0. 82 (0. 19–2. 65) vs 0. 47 (0. 24–0. 70) μg/μmol, p < 0. 0001) were significantly higher in VLBW infants than those in full‐term infants. By univariate analyses for all neonates, there were significant relations between plasma thrombomodulin concentration and gestational age, birthweight, plasma pH, creatinine concentration, platelet count and antithrombin in activity. A stepwise multiple linear regression model using the above variables as dependent factors showed only birthweight contributed significantly to plasma thrombomodulin concentration (plasma thrombomodulin concentration (μg/1) = 45. 677–0. 006 (birthweight; g), r2= 0. 323, p < 0. 0001, n= 94). Plasma thrombomodulin concentration and plasma thrombomodulin‐to ‐serum creatinine ratio in VLBW infants with asphyxia were higher than in those without asphyxia, but not significantly different (43. 2 ± 17. 7 vs 38. 3 ± 8. 5 μg/1 and 0. 92 ± 0. 60 vs 0. 83 ± 0. 37 μg/μmol). Conclusion: Plasma thrombomodulin level in VLBW infants shows a high value at birth, and we consider the main factor responsible for this elevation may be endothelial damage or low clearance rate of thrombomodulin, which may be related to early gestational age.

A young infant with Goldbloom syndrome

The patient was a Japanese girl who was the second child of unrelated, healthy parents. Hydrocephalus was disclosed on fetal ultrasonography at 33 weeks gestation, which prompted the obstetrician to perform a cesarean section at 34 weeks gestation. Birth weight was 2418 g, height 45 cm and head circumference 35.6 cm. Apgar scores were 8 and 10 at 1 and 5 min, respectively. She underwent ventriculo-peritoneal shunt for congenital aqueduct stenosis at 10 days of age. Tonicclonic convulsion commenced at 3 months of age, but it was well controlled by anti-convulsant medication. At 4 months of age, she was brought to our medical service with a 3 day history of febrile illness and painful swelling of the left knee joint. Physical examination revealed swelling, tenderness and warmth of the thigh without alteration of the overlying skin. Joint fluid in the knee was not overt. Laboratory examination disclosed an increased erythrocyte sedimentation rate (ESR, 45 mm/h), increased C-reactive protein (CRP, 2.6 mg/dL) and increased white blood cell count (WBC, 20 000/mm3). Other laboratory data including Ca, P, alkaline phosphatase and tests for syphilis and tuberculosis were normal. Blood culture was Pediatrics International (1999) 41, 110–112

Premature Infant With Severe Periventricular Leukomalacia Associated With a Large Placental Chorioangioma: A Case Report

We present the first reported case of severe periventricular leukomalacia associated with a large placental chorioangioma. We believe that the large chorioangioma near the point of umbilical cord insertion was not only disrupting fetoplacental circulation but may also have led to the periventricular leukomalacia lesions.