Emily Knaup

Recurrent apnea in an infant with pertussis due to household transmission

Bordetella pertussis causes life‐threatening apnea in infants. Lymphocytosis is an important clue for diagnosis and for determining the severity of pertussis. Antibiotics do not shorten or ameliorate the disease and only decrease the risk of transmission. Antepartum maternal immunization is important for preventing pertussis in infants.

Development of a Japanese scale for assessment of paediatric normal weight.

The Broselow tape (BT) system has helped health care profesionals succeed in avoiding errors made in paediatric acute care.1 lthough the BT has been used worldwide, it is not surprising that his American-based scale has limited applicability to paediatric opulations outside of the United States.2,3 We therefore aimed o develop a length-based weight estimation scale for Japanese hildren, the Japanese Paediatric Assessment of Normal weight JAPAN) scale. We used data of participants in a large, ongoing ongitudinal survey conducted in Japan (the Longitudinal Survey f Babies in the 21st Century4), to achieve better performance of he JAPAN scale. We also described our method of developing the cale. We obtained 370,980 measurements of body weight and height rom 39,547 participants 12–155 months old. We created the APAN scale using 75% of measurements, randomly selected from he total using the Stata random-number function binomial. We alculated and listed means of weight (kg) and the number of amples according to height, ranging from 45 cm to 179 cm, in n integral format. We then linked weight with height, begining with a height of 72 cm, with more than 100 measurements. p to 19 kg, we rounded means of weight to whole numbers and hecked the corresponding heights. For weights between 19 kg nd 36 kg, we considered the means of weights 19.5–20.9 kg to e 20 kg, those of 21.0–22.9 kg to be 22 kg, and so on up to 6 kg, and checked the corresponding heights. To check validity f the scale compared with the BT (2007 and 2011 versions), we pplied the three scales to the remaining 25% of measurements nd calculated mean absolute error as well as root mean square rror (RMSE) for each scale.5 Stata Statistical Software Release 13 StataCorp LP, College Station, TX, USA) was used for all analyes. The relationship between weight and ranges of height for the APAN scale is shown in Table 1. The newly developed JAPAN scale erformed better than the 2007 and 2011 versions of the BT. For the APAN scale vs. the BT 2007 vs. the BT 2011, mean absolute error kg) was 1.79 vs. 1.85 vs. 1.91, and RMSE (kg) was 2.77 vs. 2.92 vs. .80, respectively. Considering that the JAPAN scale was developed based on a apanese paediatric population and performed best for Japanese hildren, each country should develop a similar weight estimation cale for its own paediatric population, using available anthroometric data. Because of changing paediatric growth patterns ithin each country, these weight estimation methods should be pdated or re-evaluated regularly. Use of an appropriate scale in an 4

Targeted age, device deployment, and problems associated with pediatric defibrillation in pediatric prehospital emergency medical care settings in Japan

The use of automated external defibrillators was expanded to include infants according to the 2010 cardiopulmonary resuscitation guidelines in Japan. However, deployment has been slower for pediatric patients in Japan, because there are fewer appropriate pediatric patients for automated external defibrillators than adults. This study aimed to investigate the targeted age range for pediatric defibrillation and device deployment of defibrillators for pediatric patients in prehospital emergency medical care settings in Japan, and present the issues associated with automated external defibrillators.

Acute respiratory distress syndrome in a child with severe epileptic disorder treated successfully by extracorporeal membrane oxygenation: a case report

BackgroundExtracorporeal membrane oxygenation (ECMO) is now a candidate therapy for children with acute respiratory failure.Case presentationWe report our experience of using central ECMO therapy for acute respiratory distress syndrome followed by seizure in a 15-month-old girl with a severe epileptic disorder. Her respiratory distress was refractory to standard medical treatment and mechanical ventilatory support. Her condition was complicated by development of a pneumothorax. The patient was successfully weaned off ECMO and discharged without deterioration of her neurological status.ConclusionThe successful outcome in this case resulted from the central ECMO, which enabled “lung rest” and adequate cerebral blood flow. In skilled ECMO facilities, early implementation of ECMO would give some advantages to patients such as the one presented here. Given the invasiveness and the ease of the procedure, introduction of dual-lumen catheters adequately sized for pediatric patients in Japan is required.

Medical equipment deployment in pediatric emergency prehospital medical units in Japan

The deployment status of pediatric emergency equipment in ambulances in Japan is unknown. To investigate the status of and issues associated with prehospital emergency medical care for pediatric patients, we conducted a descriptive epidemiological study. We carried out a Web‐based survey of 767 fire defense headquarters in Japan, of which 671 responded (valid response rate, 88%). Most of the fire defense headquarters equipped all of their ambulances with oxygen masks (82%), bag‐valve masks (for neonates, 83%; for children, 84%), straight laryngoscope blades (for neonates, 47%; for children 68%), blood pressure cuffs for children (91%), oximeter probes (78%), and stiff neck collars (91%); but despite the need for other equipment such as nasopharyngeal and oropharyngeal airways, and Magill forceps, they were insufficiently deployed. In Japan, prehospital emergency medical equipment deployment does not meet the needs of pediatric patients. Minimum equipment standards need to be established for pediatric prehospital care.

New age‐based weight estimation formulae for Japanese children

Although dosing and sizing of resuscitation drugs and equipment are mostly weight based, time is usually insufficient to weigh critically ill children. Many age‐based weight estimation formulae for emergency use have been developed worldwide, but there is no specific formula for Japanese children. The aim of this study was therefore to develop and validate age‐based formulae for estimating the bodyweight of children living in Japan.

Ditch-related falls: Need for preventive educational campaigns

Dear Editor, We previously reported on 13 ditch-related injury cases in Okayama in Acute Medicine and Surgery. Since then we have focused on preventive educational campaigns through mass media in our community. However, tragic ditchrelated falls involving children have still occurred. Here we describe three subsequent pediatric cases related to ditch falls. A 3-year-old boy presented after falling into a ditch with water at a depth of 1 m. He was rescued by his mother after being swept downstream for 1 m. His level of consciousness diminished soon after rescue. However, he showed neither major trauma nor neurological sequelae. A 3-year-old boy was transported to our hospital with cardiopulmonary arrest after drowning in a ditch with water at a depth of 110 cm. He was found 1 h after he went missing. He was hypothermic (34.1°C) and extracorporeal cardiopulmonary resuscitation was performed. Unfortunately, he died of multiple organ failure 8 h later. He had no major trauma. A 4-year-old boy was transported to our hospital with cardiopulmonary arrest after drowning in a ditch with water at a depth of 90 cm. He was found 20 min after he went missing. Extracorporeal cardiopulmonary resuscitation was performed. He was weaned off extracorporeal membrane oxygenation on day 6. Unfortunately, he died of brain edema on day 33. Our previous report detailed the characteristics of severe ditch-related injury cases, which included being middleaged, bicycles, night-time incidents, and late presentation in rural areas. We suggested these characteristics as targets of preventive educational campaigns. Table 1 shows the characteristics of the three pediatric cases described in this letter. It indicates the devastating consequences of unsupervised toddlers falling into ditches and drowning in broad daylight in urban areas. Considering that unintentional accidents are the leading cause of pediatric death in Japan, urgent action to prevent ditch-related falls is desperately needed. According to an official document released by the Okayama city council, the city contains 4,000 km of irrigation ditches. As the total ditch length in Japan amounts to 400,000 km, Okayama city should act to prevent the significant risk of falling and drowning. In our previous report, we suggested considerable local government intervention. However, as the scale of the problem is immense because of the area involved, the government response will need to be assisted with educational campaigns. Therefore, preventive educational action should be conducted across multiple fields, not only in public administration but also in academic communities to help prevent pediatric death through ditch falls. We have been interviewed about ditch-related injuries by a city councilman, and have reported on ditch-related falls to pediatricians in our community through conference presentations. It is desirable that educational campaigns aimed at children involve educational institutions. Informative posters, with the help of primary care clinics and public transportation facilities, would be a helpful tool in further educational campaigns to increase the range of citizens reached. Finally, we appeal for the importance of additional surveys in relation to ditch-related falls throughout the whole of Okayama Prefecture.

Abnormal ranges of vital signs in children in Japanese prehospital settings

The revised Fire Service Law obliges each prefectural government in Japan to establish a prehospital acuity scale. The Foundation for Ambulance Service Development (FASD) created an acuity scale for use as a reference. Our preliminary survey revealed that 32 of 47 prefectures directly applied the FASD scale for children. This scale shows abnormal ranges of heart rate and respiratory rate in young children. This study aimed to evaluate the validity of the abnormal ranges on the FASD scale to assess its overall performance for triage purposes in paediatric patients.