Kazuo Seki

Severity of chorioamnionitis and neonatal outcome

Aim:  The aim of this study is to elucidate whether the stage of chorioamnionitis is or is not associated with the development of neonatal diseases.

Urinary β2-microglobulin in premature infants with chorioamnionitis and chronic lung disease

Abstract The urinary β 2 -microglobulin (MG) concentration on day 0 to 2 was significantly higher in premature infants with chorioamnionitis (CAM) than in infants without CAM and in infants who developed chronic lung disease (CLD) than in those who did not. We propose that an elevated urinary β 2 -MG can indicate a fetal inflammatory response and identify neonates at risk for the development of CLD.

Cerebral blood flow velocity in two patients with neonatal cerebral infarction

Cerebral blood flow velocity was measured in the middle cerebral artery of two patients who exhibited unilateral neonatal cerebral infarction during the neonatal period. Doppler studies demonstrated increases in cerebral blood flow velocity but decreases in the resistance index on the affected side of the middle cerebral artery in the neonate who developed hemiplegia with cystic encephalomalacia, although the neonate with normal neurologic outcome exhibited symmetric cerebral blood flow velocity and resistance index. The asymmetry in cerebral blood flow velocity measurements of both middle cerebral arteries may be useful to evaluate the severity of brain damage and predict the neurodevelopmental prognosis of unilateral neonatal cerebral infarction.

Early discharge from a neonatal intensive care unit and rates of readmission

Background:  Increasing admissions to neonatal intensive care units (NICUs) demand early discharge from the units. Our hospital aims to early discharge patients who meet the following requirements: they are able to regulate body temperature; neither apnea nor bradycardia is observed; and bodyweight increases with lactation. We studied the real state of this strategy.

Blood Flow Velocities in the Anterior Cerebral Artery and Basilar Artery in Asphyxiated Infants

Objective. The aim of this series was to determine whether cerebral blood flow velocities (CBFVs) in the anterior cerebral artery (ACA) and basilar artery (BA) correlate with the severity of asphyxia in infants and whether these velocity measures can be useful for predicting early developmental prognosis. Methods. We measured CBFVs in the ACA and BA by using pulsed Doppler sonography in 29 healthy and 17 asphyxiated infants (11 with mild asphyxia [median gestational age, 38 weeks; median birth weight, 2856 g] and 6 with severe asphyxia [38.5 weeks; 2910 g]). Results. In the mildly asphyxiated infants, the median diastolic and systolic velocities in the ACA were 10.4 and 32.5 cm/s, respectively, and those in the BA were 10.5 and 33.1 cm/sec. In the severely asphyxiated infants, the median diastolic and systolic velocities in the ACA were 19.8 and 40.5 cm/s, and those in the BA were 30.2 and 60.5 cm/s. The BA:ACA ratios (CBFV in the BA/CBFV in the ACA) in both the diastolic and systolic periods were higher in the severely asphyxiated infants than in the mildly asphyxiated infants (0.94 versus 1.35; P < .01; 1.01 versus 1.38; P < .01). Conclusions. These preliminary results suggest that CBFVs in the BA correlate with the degree of neonatal asphyxia and may be useful to predict the neurodevelopmental outcome. We submit that the increased CBFV in the BA may represent the preferential blood flow to the brain stem region.

Long-term survival in a 69,XXX triploid premature infant†

Triploidy is a chromosomal abnormality in which there is an excess number of chromosomes due to an extra haploid set. It occurs in 1–3% of pregnancies [Jacobs et al., 1978]; however, the majority result in spontaneous abortion in early pregnancy. Therefore, cases which reach birth are rare. Even if an infant is born, death occurs during the neonatal period so that the number of reported cases of long-term survival is very low [Cassidy et al., 1977; Fryns et al., 1977; Schröcksnadel et al., 1982; Faix et al., 1984; Strobel and Brandt, 1985; Arvidsson et al., 1986; Sherard et al., 1986; McFadden and Kalousek, 1991; Niemann-Seyde et al., 1993; Hasegawa et al., 1999; Iliopoulos et al., 2005]. Compared to previous reports, our patient described here, was the most premature and had the smallest birth weight, but survived the second longest of any infant. The mother, 36 years old, and the father, 35 years old, were not related other than by marriage. There was no significant past medical history and she was 1 gravida and 0 para. The pregnancy was uncomplicated. Since intrauterine growth retardation (IUGR) was noted from around 26 weeks of gestation, she was referred to our center at 29 weeks and 2 days of gestation. Fetal sonographic examination showed the head biparietal diameter of 65 mm (equivalent to 25 weeks and 4 days), the femur length of 40 mm (equivalent to 23 weeks and 3 days) and the estimated fetal body weight of 659 g. Therefore, severe IUGR was noted; however, the amount of amniotic fluid was normal and there were no abnormalities in the umbilical artery blood flow. Because of the findings, chromosomal analysis of the amniotic fluid was scheduled. However, at 29 weeks and 5 days of gestation, the fetal monitor showed prolonged bradycardia. Therefore, an emergency cesarean was performed. The baby was female, small for the gestational age with a birth weight of 566 g ( 3.3 SD), length of 28 cm ( 2.8 SD), head circumference of 24 cm ( 1.1 SD) and chest circumference of 16 cm ( 3.0 SD). Large head relative to body size was recognized. Apgar scores were 1 point at 1 min and 6 points at 5 min. Marked hypotonia and external malformations including frontal bossing, apparent hypertelorism, blephalopimosis, micrognathia, microstomia, low-set ears, bell-shaped thorax, syndactyly, clinodactyly, camptodactyly, and malposition of fingers were noted (Fig. 1). From the external findings, oto-palato-digital syndrome (OPD syndrome) was suspected. The placenta weighed 72 g and was markedly small. The umbilical cord was 19 cm long and was markedly short. There were no cystic villi. The chest radiograph showed the hypoplasia of the thorax and decreased lung permeability. Radiographs of the limbs showed the metaphyseal irregularities of the long bones and defect of the calcaneus. Cardiac sonogram showed patent ductus arteriosus (4.4 mm in diameter), atrial septal defect, ventricular septal defect (3 mm in diameter), and

Decreased serum osmolality promotes ductus arteriosus constriction

AIMS At birth, dynamic changes occur in serum components and haemodynamics, such as closure of the ductus arteriosus (DA). A previous study demonstrated that, in full-term human neonates, serum osmolality decreased transiently after birth, but recovered over the next few days. However, the significance of this transient decrease in osmolality has never been addressed. The objective of the present study was to examine the role of changes in serum osmolality after birth in DA closure. METHODS AND RESULTS We found that rats exhibited a similar transient hypoosmolality after birth. Hypotonic stimulation induced constriction of DA rings and increased Ca(2+) transient in DA smooth muscle cells, but not in the aorta. The hypoosmotic sensor transient receptor potential melastatin 3 (TRPM3) was highly expressed in the rat DA, and TRPM3 silencing abolished the Ca(2+) response to hypoosmolality. Pregnenolone sulfate stimulation of TRPM3 induced rat DA constriction ex vivo and in vivo. Furthermore, hypertonic fluid injection impaired rat DA closure. In humans, neonatal serum hypoosmolality was observed in relatively mature preterm infants (≥28 weeks). In extremely preterm infants (<28 weeks), however, this hypoosmolality was absent. Instead, a rapid increase in osmolality occurred thereafter. Such an increase was greater, in particular, among patent DA (PDA) patients. CONCLUSIONS A transient decrease in serum osmolality may promote DA closure during the first few days of life. Adjusting serum osmolality to proper levels might help to prevent the onset of PDA, improving the therapeutic outcome in extremely preterm infants.

Immune response to Haemophilus influenzae type b conjugate vaccine in preterm infants.

Background:  Haemophilus influenzae type b (Hib) vaccine became available for use in Japan in December 2008. The aim of the present study was to evaluate the immunogenicity of Hib vaccine in Japanese preterm infants.

AN IMBALANCE BETWEEN PROSTACYCLIN AND THROMBOXANE IN RELATION TO CEREBRAL BLOOD FLOW IN NEONATES WITH MATERNAL PREECLAMPSIA

OBJECTIVE A disturbance of prostacyclin (PGI2) and thromboxane A2 (TXA2) balance has been reported in preeclampsia. However, little is known about the concentrations of these prostanoids in neonates born to preeclamptic pregnant women. The purpose of this study is to determine whether the PGI2 and TXA2 concentrations are altered and whether the prostanoid balance correlates to the cerebral blood flow in neonates born to preeclampsia. METHODS Spontaneously voided urine samples were collected from 20 neonates of normotensive and 16 neonates of preeclamptic women during the first 24 h after birth. We measured by radioimmunoassay the concentrations of urinary 6-keto-prostaglandin F1alpha (6-keto-PGF1alpha) and 11-dehydro-thromboxane B2 (11-dehydro-TXB2), respectively. Blood flow velocity in the middle cerebral artery was studied by pulsed Doppler ultrasonography in the neonates between 17 and 38 h after birth. RESULTS There was no significant difference between the urinary 6-keto-PGF1alpha in the neonates of mothers with and without preeclampsia (median, 5.3 vs. 3.6 ng/mg of creatinine). In contrast, the urinary 11-dehydro-TXB2 and the ratio of 11-dehydro-TXB2 to 6-keto-PGF1alpha in the neonates of mothers with preeclampsia were significantly lower as compared with the neonates without preeclampsia, respectively (13.7 vs. 20.6 ng/mg of creatinine and 3.0 vs. 5.2, median). The resistance index in the middle cerebral artery was significantly reduced in the neonates with preeclampsia than without preeclampsia (0.67 +/- 0.01 vs. 0.74 +/- 0.02, mean +/- SEM). CONCLUSIONS There was an association between maternal preeclampsia and the imbalance in the neonatal urinary excretion of PGI2 and TXA2 metabolites. This imbalance may contribute to the regulation of cerebral blood flow.

Cerebral blood flow velocities in the anterior cerebral arteries and basilar artery in hydrocephalus before and after treatment

We studied Pourcelots index (PI), which shows cerebral vascular resistance, in the anterior cerebral arteries and basilar artery, and the PI ratio (Pourcelots index in the anterior cerebral artery/Pourcelots index in the basilar artery) in 11 measurements of hydrocephalus. The mean values of PI in the anterior cerebral artery, basilar artery, and the PI ratio before treatment were significantly higher than those after treatment and those in normal infants. Before treatment, the mean PI in the anterior cerebral arteries was significantly higher than the mean PI in the basilar artery. All PI ratios increased to 1.00 or more. After treatment and in normal infants, the mean PI in the anterior cerebral arteries was significantly lower than the mean PI in the basilar artery. All PI ratios decreased to less than 1.00. We believe that the PI ratio is useful to evaluate the need or effect of treatment in hydrocephalus.