Hitomi Sakai

Serum unbound bilirubin as a predictor for clinical kernicterus in extremely low birth weight infants at a late age in the neonatal intensive care unit

BACKGROUND This study aimed to evaluate peak serum total bilirubin (TB) and unbound bilirubin (UB) levels in preterm infants with clinical kernicterus (KI) who were diagnosed by clinical findings during infancy. DESIGN/SUBJECTS For this multicenter retrospective study, 18 Japanese extremely low birth weight (ELBW) infants with clinical KI were included. Clinical KI was diagnosed based on the presence of motor developmental impairment with/without athetosis, and abnormal magnetic resonance imaging or brainstem auditory evoked potential findings during infancy. High and low TB or UB levels were defined as serum TB levels ⩾ and <15 mg/dL or serum UB levels ⩾ and <0.8 μg/dL, respectively. The clinical characteristics of KI preterm infants were analyzed. The proportion of infants with high or low serum TB levels and with high or low serum UB levels was then investigated. Sensitivity and specificity were calculated. RESULTS In 18 KI infants, the median age when serum TB levels peaked was 28 days after birth. In eight KI infants with low serum TB levels, 88% of them had high serum UB levels. For comparison of the number of infants who had high or low serum TB and UB levels, the sensitivity was 90% and specificity was 13%. CONCLUSIONS Serum TB and UB levels peak at a later age than expected. Chronic serum UB monitoring may be helpful for identifying ELBW infants at risk for developing KI, even when they do not have high serum TB levels.

Effect of hydrocortisone therapy on severe leaky lung syndrome in ventilated preterm infants

Background:  The aim of this study was (i) to determine the incidence and risk factors of severe leaky lung syndrome (sLLS), persistent pulmonary edema characterized by massive tracheal secretions and resistance to surfactant therapy, in extremely low gestational age newborns requiring ventilatory support; and (ii) to evaluate the effects of hydrocortisone (HC) therapy for sLLS on tracheal aspirate fluid (TAF) volume and β2‐microglobulin levels in TAF.

Prophylactic indomethacin in extremely premature infants between 23 and 24 weeks gestation

Background:  In extremely premature infants, the presence of a left‐to‐right shunt through a patent ductus arteriosus (PDA) increases the risks of pulmonary hemorrhage, intraventricular hemorrhage, necrotizing enterocolitis, renal failure, and chronic lung disease. Conservative management induces spontaneous ductus closure in <20% of extremely premature infants (infants born at <25 weeks of gestation). The aim of the present study was to determine the efficacy and safety of prophylactic indomethacin (INDO) administration for PDA closure in extremely premature infants born between 23 and 24 weeks of gestation.

Patterns of increases in interleukin-6 and C-reactive protein as predictors for white matter injury in preterm infants

The aim of this study was to determine whether patterns of increases in serum interleukin‐6 (IL‐6) and C‐reactive protein (CRP) levels at birth were associated with the development of white matter injury (WMI) in preterm infants with a fetal inflammatory response (FIR).

N-terminal pro-brain natriuretic peptide levels in monochorionic diamniotic twins with selective intrauterine growth restriction

Objective:To compare serum N-terminal pro-brain natriuretic peptide levels at birth between monochorionic diamniotic twins with and without selective intrauterine growth restriction.Study Design:Blood samples were collected from 73 monochorionic diamniotic twins without twin-to-twin transfusion syndrome. Two groups were studied on the basis of fetal ultrasonographic findings: 16 twins with and 57 twins without selective intrauterine growth restriction. Selective intrauterine growth restriction was defined as an estimated fetal weight below the 10th percentile in one twin at 18 to 26 weeks of gestation. Serum N-terminal pro-brain natriuretic peptide levels were measured.Result:Serum N-terminal pro-brain natriuretic peptide levels in monochorionic diamniotic twins with selective intrauterine growth restriction were significantly higher than in those without selective intrauterine growth restriction. Selective intrauterine growth restriction was independently associated with increased N-terminal pro-brain natriuretic peptide levels.Conclusion:N-terminal pro-brain natriuretic peptide levels at birth are elevated in monochorionic diamniotic twins with selective intrauterine growth restriction.

Surfactant lavage therapy for respiratory deterioration in extremely premature infants

The following article from Pediatrics International, ‘Surfactant lavage therapy for respiratory deterioration in extremely premature infants’ by Sota Iwatani, Masami Mizobuchi, Satoshi Tanaka, Kei Inomata, Hitomi Sakai, Seiji Yoshimoto and Hideto Nakao, posted online as an Accepted Article on 30 October 2012 in Wiley Online Library (wileyonlinelibrary.com), has been withdrawn by agreement between the authors, the journal Editor in Chief, and Wiley Publishing Asia Pty. Ltd. The withdrawal has been agreed due to deficiencies in the study design.

Increased volume of tracheal aspirate fluid predicts the development of bronchopulmonary dysplasia.

BACKGROUND Elevated cytokine concentrations were observed in tracheal aspirate fluid (TAF) of infants on mechanical ventilation who subsequently developed bronchopulmonary dysplasia (BPD). However, there are few reports that systematically evaluate the amount of TAF as an indicator of BPD development. AIM To clarify whether TAF volume during the first week of life predicts BPD development in extremely low gestational age newborns (ELGANs). STUDY DESIGN We analyzed 51 infants, born at gestational age of <28 weeks and ventilated for more than 7 days after birth, among whom, 26 were diagnosed with BPD based on the clinical definition of oxygen dependence at 36 weeks postmenstrual age (BPD group) and 25 were included in the non-BPD group. Sum of TAF scores (STS) was calculated by semi-quantification of TAF volume at each suctioning and the suctioning frequency during the first week of life. RESULTS STS was significantly higher in the BPD group than in the non-BPD group (median (interquartile range): 77 (29-126) vs. 28 (22-59), p<0.001). STS (cut-off, 60) with area under the curve in receiver operating analysis of 0.75 was significantly predictive of BPD development. Multivariate logistic regression analysis adjusted for perinatal characteristics showed that STS≥60 was a significant risk factor for BPD development (odds ratio, 7.50; confidence interval, 1.16-48.40, p=0.034). CONCLUSION Increased TAF volume during the first week of life was an independent predictor for BPD development in ventilated ELGANs, indicating that increased pulmonary capillary permeability may influence the pathogenesis of BPD.

Very Low Birth Weight Monochorionic Diamniotic Twins as a Risk Factor for Symptomatic Patent Ductus Arteriosus.

Background: Some prior studies have shown that symptomatic patent ductus arteriosus (sPDA) is highly familial. Although it is estimated that both genetic and environmental factors may contribute to sPDA, evidence is still lacking. Objective: The aim of this study was to determine the risk factors for sPDA, focusing on the genetic and in utero environment by analyzing very low birth weight (VLBW) singletons and twins. Methods: This retrospective case-control study reviewed the medical records of 445 VLBW infants (25 weeks ≤ gestational age <32 weeks, 600 g ≤ birth weight <1,500 g) and compared the incidence of sPDA among monochorionic diamniotic (MD) twins (n = 65), dichorionic diamniotic (DD) twins (n = 66), and singletons (n = 314). Results: Stepwise multiple regression analysis showed that twin siblings (p = 0.001), gestational week (p < 0.001), antenatal steroid use (p = 0.021), and premature rupture of membranes (p = 0.002) were independent predictors of sPDA. Incidence of sPDA in MD twin siblings was significantly higher than that in singletons (p < 0.01), whereas no significant difference was found between singletons and DD twins or between MD and DD twins. Conclusions: The current results show that being a VLBW MD twin is an independent risk factor for sPDA, and that both genetic and in utero environmental factors may contribute to its development.

588 Perinatal Factors Associated with Multiple Large Cysts on Chest Computed Tomography in Extremely Premature Infants with Chronic Lung Disease

Objective To identify perinatal factors associated with multiple large cysts on chest computed tomography (CT) in extremely premature infants with chronic lung disease (CLD). Methods A case-control study of 87 infants with CLD who were ≤28 weeks’ gestation, admitted between 2005 and 2010, and underwent chest CT. CLD was defined as the need for supplemental oxygen at 36 weeks’ postmenstrual age (PMA). A chest CT was performed at between 36 and 44 weeks’ PMA. Nine infants had multiple large cysts (≥5mm) throughout the lung fields on chest CT (MLC group), and 78 had no or a few localized large cysts on chest CT (controls). Perinatal factors including placental histology was were compared between the groups. Results The incidence of premature rupture of the membranes (PROM) and histological chorioamnionitis (HC) was significantly higher in the MLC group than in controls. Significantly more infants in the MLC group had an elevated level of serum IgM (≥30 mg/dl) at birth than in controls. The severity of respiratory distress syndrome (RDS) was significantly reduced in the MLC group compared with controls. Conclusions The presence of multiple large cysts on chest CT is associated with an increased incidence of PROM and HC, elevated levels of serum IgM and reduced severity of RDS in extremely premature infants with CLD. These findings suggest that the presence of chronic intrauterine inflammation and the acceleration of fetal lung maturation may play important role in the formation of large cysts in the developing lung.