Hirofumi Kimoto

Successful transcutaneous arterial embolization of a giant hemangioma associated with high-output cardiac failure and Kasabach-Merritt syndrome in a neonate : A case report

Abstract We describe the case of a patient with a neonatal giant cutaneous hemangioma with high-output cardiac failure and Kasabach-Merritt syndrome and successfully treated with transcutaneous arterial embolization aimed at controlling severe congestive heart failure and consumption coagulopathy. A patient was admitted to the neonatal care unit on the first day of age because of a large hemangioma on his right lateral chest wall and respiratory distress, associated with cardiac failure resulting from arteriovenous shunting. On the second day of age the platelet count decreased to 5.7 × 104/μl and fibrinogen level was 85 mg/dl. The values of prothrombin time and activated partial thromboplastin time were prolonged. Intravenous predonisone therapy was started immediately, but bleeding tendency was getting worse and the evidence of congestive heart failure persisted. On the third day the patient then underwent embolization of feeding arteries with microcoils. The cardiac failure and thrombocytopenic coagulopathy had improved significantly without complications. We conclude that transcutaneous arterial embolization is an effective and safe treatment in this neonate and should be considered for the treatment of control high-output cardiac failure and coagulopathy in infants with hemangioma and Kasabach-Merritt syndrome.

Effects of albumin infusion therapy on total and unbound bilirubin values in term infants with intensive phototherapy

Background : The purpose of the present study was to evaluate the effect of intravenous albumin administration on the serum total and unbound bilirubin values in term non‐hemolytic hyperbilirubinemic neonates during intensive phototherapy.

Follow-up study of auditory brainstem responses in infants with high unbound bilirubin levels treated with albumin infusion therapy.

Background : Several authors reported that there was a close relationship between unbound bilirubin concentrations and abnormal results of auditory brainstem responses. Full‐term infants with high‐unbound bilirubin concentrations who were treated with human albumin were followed to evaluate their hearing abilities by using auditory brainstem responses.

Morbidity and mortality of infants born at the threshold of viability : Ten years' experience in a single neonatal intensive care unit, 1991-2000

Background: The purpose of the present paper was to evaluate the mortality and morbidity of infants born at 22–24 weeks gestation.

Cerebral hemodynamics on near-infrared spectroscopy in hypoxia and ischemia in young animal studies

Using near-infrared spectroscopy the changes of intracranial oxyhemoglobin, deoxyhemoglobin, total hemoglobin and cytochrome aa3, which show the progression of intracranial oxygenation, hemodynamics and cell metabolism, were recorded during prolonged partial hypoxia induced by carbon dioxide (CO2) and nitrogen (N2), ischemia induced by hyperventilation, and hypoxia during hypoglycemia in neonatal and young rabbits. The reduction of cytochrome aa3 during the terminal stage of CO2-induced prolonged hypoxia, hyperventilation and hypoxia in hypoglycemia suggests that the redox state of cytochrome aa3 will be changed by several combined factors such as oxygen delivery, ATP demand and substrate (glucose) delivery.

Developmental outcomes in persistent pulmonary hypertension treated with nitric oxide therapy

Background:  The aim of the present study was to assess 3 year auditory and neurodevelopmental outcomes of persistent pulmonary hypertension of the newborn (PPHN) before and after introducing inhaled nitric oxide (i‐NO) therapy, and to detect the clinical factors affecting poor outcome.

Reduction in blood glucose values following indomethacin therapy for patent ductus arteriosus.

Abstract Purpose: To evaluate the effects of indomethacin on blood glucose values in premature infants with patent ductus arteriosus (PDA).

Inhaled nitric oxide therapy might reduce the need for hyperventilation therapy in infants with persistent pulmonary hypertension of the newborn

Abstract Aim: To determine whether inhaled nitric oxide might reduce the need for excessive respiratory alkalosis to maintain systemic oxygenation in infants with persistent pulmonary hypertension of the newborn (PPHN). Materials and methods: A retrospective historical cohort study of 34 infants with PPHN with oxygenation index (OI) of 25 or more, including 19 infants without inhaled nitric oxide (i-NO) therapy (control group) and 15 infants with inhaled nitric oxide therapy (i-NO group) was performed. The initial dose of 10 ppm of i-NO was administered and no responders received the maximum dose of 25 ppm. We evaluated the mortality rate and the change of OI index and PaCO2 during the first 6 days. Results: There were no significant differences in characteristics between groups. Two of 15 in the i-NO group and 6 of 19 infants in the control group died during the first 48 h. Baseline OI, PaCO2 and arterial pH were similar in the two groups. OI in the i-NO group was significantly higher than in the control group between 12 and 96 h. PaCO2 in the i-NO group was higher than in the control group between 24 and 144 h. Conclusion: i-NO therapy for PPHN might improve systemic oxygenation without excessive hypocapnia. However there was no reduction in duration of ventilation support or oxygen supply.

Intractable hypoglycemia following indomethacin therapy for patent ductus arteriosus.

described simultaneously the administration of indomethacin, a prostaglandin synthetase inhibitor, to produce pharmacological closure of the ductus arteriosus in symptomatic premature infants. The use of indomethacin has rapidly replaced surgical ligation as the primary therapy to close a patent ductus arteriosus (PDA). However, indomethacin therapy may induce several serious adverse effects, such as transient renal dysfunction, decreased platelet aggregation and gastrointestinal disturbances. Many decreased blood glucose values are speculated to be related to indomethacin therapy. There have been few literature reports of indomethacin-induced hypoglycemia.3,4 Studies in vitro and in vivo suggested that prostaglandins might participate in the regulation of insulin and glucagon secretion.3 However, the mechanism by which indomethacin induced a drop in the blood glucose level in the newborn is still unclear. In this report, we describe a premature infant with intractable hypoglycemia due to hyperinsulinemia following intravenous indomethacin therapy for PDA. This infant was successfully treated with hydrocortisone.

The effect of acetazolamide and carbon dioxide on cerebral hemodynamic changes on near-infrared spectroscopy in young rabbits

The changes of cerebral blood oxyhemoglobin (HbO2), deoxyhemoglobin (HbR), and total hemoglobin (tHb) induced by acetazolamide and CO2 loading on near-infrared spectroscopy (NIRS) were recorded. In anesthetized 2-week-old rabbits, acetazolamide (10 mg/kg i.v.) increased HbO2 and tHb, concomitant with an increase in tissue PCO2, and decreased HbR only at 5 and 10 min. CO2 loading significantly increased HbR and decreased HbO2, and after the termination of CO2 loading, tHb and HbO2 significantly increased and HbR decreased to nearly the baseline value. Thus, NIRS demonstrated cerebral hemodynamic responses as a function of vasomotor reactivity to acetazolamide as well as CO2 loading.