Daijiro Takahashi

Vitamin K prophylaxis and late vitamin K deficiency bleeding in infants: Fifth nationwide survey in Japan

Background:  In 1980, the first nationwide survey on late vitamin K deficiency bleeding (VKDB) in infants was conducted in Japan, and it was followed by the second, third and fourth nationwide surveys in 1985, 1988 and 1991, respectively. The fifth nationwide survey was designed to ascertain the epidemiology of late VKDB between January 1999 and December 2004.

Population‐based study of esophageal and small intestinal atresia/stenosis

The aim of this study was to describe the prevalence of esophageal atresia/stenosis and small intestinal atresia/stenosis in Nagano, Japan, together with associated anomalies, prenatal diagnosis and survival.

Effect of transfusion on the venous blood lactate level in very low-birthweight infants.

Background:  In recent years the blood lactate level can be easily and quickly measured with a small amount of blood, and the availability of an arterial blood lactate level has been reported as an indicator of oxygen deficit in adults. To determine whether venous blood lactate level can serve as such a marker for determining the indications for transfusion, blood lactate and hemoglobin level were monitored before and after transfusion.

Successful tracheobronchial reconstruction of communicating bronchopulmonary foregut malformation and long segment congenital tracheal stenosis: a case report

Communicating bronchopulmonary foregut malformation (CBPFM) and congenital tracheal stenosis (CTS) are difficult developmental disorders especially when they are presented simultaneously in a patient. The authors report a case of a newborn boy born at 37 weeks of gestation weighing 2356 g with CBPFM (right esophageal lung) and long segment CTS. Staged surgical repair (by-force endotracheal intubation for securing the airway followed by bronchotracheal anastomosis for CBPFM, tracheostomy with handmade, length-adjustable tracheostomy tube, and slide tracheoplasty) was performed. He has been healthy without tracheostomy for 25 months after slide tracheoplasty. This is the first report of a successful tracheobronchial reconstruction for a patient with a long segment CTS and CBPFM preserving the affected lung function.

Retrospective analysis of risk factors for development of liver dysfunction in transient leukemia of Down syndrome

About 20% of patients with transient leukemia (TL), which is a disease noted in Down syndrome, are reported to develop hepatic fibrosis, which has a poor prognosis. The clinical factors related to the poor prognosis of TL were retrospectively analyzed in 25 patients, and criteria for starting chemotherapy were established. The initiation of chemotherapy was recommended when two or more of the following categories were fulfilled in the process of the disease: (1) a reduced hepatic functional reserve estimated by direct bilirubin, prothrombin time, and the presence of ascites, (2) an elevated level of hyaluronic acid (>500 U/mL), (3) respiratory failure or poor sucking associated with hepatosplenomegaly, and (4) demonstration of fibrosis by liver biopsy. When these criteria were applied to our cases, all patients who received chemotherapy remained alive. Our criteria are useful for selecting patients with TL at high risk of developing hepatic fibrosis and for starting chemotherapy.

P eT CO 2 measured by a new lightweight mainstream capnometer with very low dead space volume offers accurate and reliable noninvasive estimation of PaCO 2

= 0.9099, P , 0.0001) when there was no leakage in the tracheal intubation tubes. No significant differences were observed between PaCO 2 and P ET CO 2 (P a-ET CO 2 ) in the three tidal volume/body weight groups or for groups in which leakage rate was ,60%, but significant deviations in P a-ET CO 2 were noted in groups with leakage rate 60%. Conclusion: There was a strong correlation between P ET CO 2 and PaCO 2 when tidal volume/ body weight ratio was 6–15 mL/kg with leakage rate ,60%. Lightweight mainstream capnometer with a low amount of dead space airway adaptor might be useful in very low birth weight infants with small tidal volume.

Polymyxin B-immobilized fiber column direct hemoperfusion and continuous hemodiafiltration in premature neonates with systemic inflammatory response syndrome.

There have been no previous studies regarding whether combined use of Polymyxin B‐immobilized fiber column direct hemoperfusion (PMX‐DHP) and continuous hemodiafiltration (CHDF) is helpful in the treatment of preterm infants with systemic inflammatory response syndrome (SIRS) and hypercytokinemia.

Successful treatment of two cases of urorectal septum malformation sequence with oligohydramnios and severe respiratory failure

Urorectal septum malformation sequence can be diagnosed prenatally. We report herein the successful treatment of severe respiratory failure in two patients with urorectal sep- tum malformation sequence and prenatally diagnosed oligohydramnios. The patients showed significant hypoxic deterioration and persistent pulmonary artery hypertension soon after birth. We used high-frequency ventilation (HFO), nitric oxide (NO), and extracorporeal membrane oxygenation (ECMO). The patients were successfully weaned from ECMO and artificial venti - lation and discharged to home. Although termination of the pregnancy has often been selected for fetuses with oligohydramnios-related urorectal septum malformation sequence, our results suggest the opportunity for these fetuses to be treated using respiratory supports including HFO, NO, and ECMO after birth.

Late vitamin K deficiency bleeding in an infant born at a maternity hospital

Daijiro Takahashi, Yukihiro Takahashi, Susumu Itoh, Tomizo Nishiguchi, Yoshio Matsuda and Akira Shirahata Division of Pediatrics, Fukuda Hospital, Kumamoto, Division of Neonatal Intensive Care, Nara Medical University Hospital, Center of Perinatal Medicine, Nara, Department of Pediatrics, Faculty of Medicine, Kagawa University, Kagawa, Department of Maternal Care Unit, Shizuoka Children’s Hospital, Shizuoka, Department of Obstetrics and Gynecology, Tokyo Women’s Medical University, Tokyo and Kitakyushu Yahatahigashi Hospital, Kitakyusyu, Japan

Evaluation of hypercoagulability using soluble fibrin monomer complex in sick newborns

Soluble fibrin monomer complex (SFMC) and fibrin monomer (FM) are well known as markers for hypercoagulability, but such measurements have not been investigated in detail for the neonate. To identify the presence of a hypercoagulable state in sick newborns, the behavior of SFMC with special reference to those of other coagulation tests, and the relationships with other parameters of blood coagulation as well as lactate, which is considered to be the gold standard for assessing tissue hypoxia, were studied.