Masaki Wada

Resuscitation of Preterm Infants with Reduced Oxygen Results in Less Oxidative Stress than Resuscitation with 100% Oxygen

The objective of this study was to determine the effects of the level of inhaled oxygen during resuscitation on the levels of free radicals and anti-oxidative capacity in the heparinized venous blood of preterm infants. Forty four preterm infants <35 weeks of gestation with mild to moderate neonatal asphyxia were randomized into two groups. The first group of infants were resuscitated with 100% oxygen (100% O2 group), while in the other group (reduced O2 group), the oxygen concentration was titrated according to pulse oximeter readings. We measured total hydroperoxide (TH) and redox potential (RP) in the plasma within 60 min of birth. The integrated excessive oxygen (∑(FiO2-0.21) × Time(min)) was higher in the 100% O2 group than in the reduced O2 group (p<0.0001). TH was higher in the 100% O2 group than in the reduced O2 group (p<0.0001). RP was not different between the 100% O2 and reduced O2 groups (p = 0.399). RP/TH ratio was lower in the 100% O2 group than in the reduced O2 group (p<0.01). We conclude that in the resuscitation of preterm infants with mild to moderate asphyxia, oxidative stress can be reduced by lowering the inspired oxygen concentration using a pulse oximeter.

Urinary acidification in extremely low birth weight infants.

Premature infants often present metabolic acidosis without protein load in the early neonatal period, around days 4-6. In order to elucidate the cause of acidosis, we investigated urinary acidification of infants in the early neonatal period. Urine pH, fractional excretion of HCO(3)(-) (FEHCO(3)), excretion of HCO(3)(-) and NH(4)(+) of the appropriate-for-date infants were measured on days 0-2 and on days 4-6 of life. Extremely low birth weight (ELBW) infants showed higher urine pH than more than 1500 g birth weight infants. FEHCO(3) and HCO(3)(-) excretion were of high values in ELBW infants on days 0-2, but decreased on days 4-6. Urine NH(4)(+) excretion rate was lower in ELBW infants than in birth weight more than 1000 g on days 0-2 of life and still remained at a low rate on days 4-6. These data indicated that insufficiency of NH(4)(+) excretion is the main cause for metabolic acidosis of ELBW infants in the early neonatal period.

Fluid and electrolyte balance in extremely preterm infants <24 weeks of gestation in the first week of life.

Background: Extremely preterm infants, especially those <24 weeks of gestation, displayed extremes in changes of fluid/electrolyte balance. The purpose of the present study was to retrospectively investigate abnormalities in fluid/electrolyte balance during the first postnatal week.

Survey of delivery room resuscitation practices at tertiary perinatal centers in Japan

The aim of this study was to determine the current neonatal resuscitation practices for term infants in Japan, immediately before the 2010 publication of the international neonatal resuscitation consensus.

Interleukin‐6 polymorphism and bronchopulmonary dysplasia risk in very low‐birthweight infants

Background:  The aim of the present study was to evaluate the role of interleukin (IL)‐6‐634 polymorphism in neonatal disorders such as bronchopulmonary dysplasia (BPD) and periventricular leukomalacia (PVL) in very low‐birthweight (VLBW) infants.

A case report of fatal tumor lysis syndrome after chemotherapy in a pregnant patient with Burkitt's lymphoma

A 35‐year‐old Japanese woman in the 24th week of gestation with bilateral breast enlargement was referred to hospital. She was diagnosed with Burkitts lymphoma and admitted for detailed evaluation and treatment. Early delivery and subsequent chemotherapy was chosen after considering the gestational week, her general condition and the wishes of the patient and her husband. She gave birth to a male infant by cesarean section in the 25th week of gestation. It had been planned to begin high‐dose chemotherapy, such as CODOX‐M/IVAC, on day 7 of the puerperium; however, her general condition worsened and chemotherapy was therefore begun on day 2 after the birth. Eight hours after chemotherapy (cyclophosphamide, vincristine and doxorubicin), she developed cardiac arrest due to tumor lysis syndrome. Despite medical treatment, her bleeding tendency did not improve and she died of respiratory failure with alveolar bleeding five days after chemotherapy.

Status of and problems concerning neonatal resuscitation in Japan in 2015.

The International Liaison Committee on Resuscitation (ILCOR) published Consensus 2015 in October 2015. Thereafter, the Japanese version of neonatal cardiopulmonary resuscitation programs was revised. Prior to the revision, we re‐conducted questionnaire surveys in three types of medical facilities in January 2015.

Plasma Free Fatty Acids in Neonates with Congenital Hypothyroidism

Since the introduction of neonatal mass screening for congenital hypothyroidism (CH), numerous cases have been detected. It is of interest that even severely hypothyroid neonates rarely exhibit bradycardia, hypothermia, or inactivity, which have been recognized as typical signs of CH. Regarding neonates and young infants, few reported data are available on the effects of thyroid hormones on energy expenditure. Plasma free fatty acids (FFAs), markers for lipolysis, play essential roles in maintaining physiologic homeostasis. To study fuel utilization in CH neonates, we measured heart rates, plasma FFA, and thyroid hormones before and after levothryoxine (LT4) replacement therapy. Fifty-five screen-detected CH neonates and 29 age-matched normal neonates for controls were enrolled. The CH neonates were divided into two groups according to serum thyroid hormone levels: a mildly hypothyroid group (n = 37), serum thyrotropin (TSH) less than 100 microIU/mL and free thyroxine (FT4) 0.6 ng/dL or more; and a severely hypothyroid group (n = 18), TSH 100 microIU/mL or more and FT4 less than 0.6 ng/dL. Twenty-four of the 55 patients had their heart rates measured by electrocardiography. Fasting blood samples were taken from the subjects during physical movements. Serum levels of TSH, FT4, FFA, and other blood chemicals, measured on an autoanalyzer system in our hospital, were compared before and after LT4 substitution therapy. The following results were obtained. The mean plasma FFA values before LT4 replacement were 208.5 +/- 89.4 microEq/L in the mildly hypothyroid group, 228.5 +/- 114.7 microEq/L in the severely hypothyroid group, and 213.9 +/- 97.7 microEq/L in controls. No statistical differences were noted among the three values. Two months after LT4 replacement therapy, at the age of 3 months, plasma FFA concentrations significantly increased in both groups compared with those before the therapy. Control infants also showed a significant increase in plasma FFA concentrations from 1 to 3 months of age. There were no significant differences in plasma FFA concentrations among the three groups at the age of 3 months. No significant correlations were found between plasma FFA and serum thyroid hormones. From these results it is suggested that in neonates and young infants, thyroid hormones do not play major roles in mobilization of fats through the adrenergic regulation of lipolysis for energy supply. This may be one of the reasons for the unexpectedly mild signs and symptoms in the screen-detected hypothyroid neonates.

Training of neonatal cardiopulmonary resuscitation instructors.

The Consensus on Science and Treatment Recommendations 2010 supported simulation‐based training for education in resuscitation. This approach has been introduced into neonatal cardiopulmonary resuscitation (NCPR) courses in Japan, but no method for teaching instructors has been established. We developed a course for training instructors of NCPR, with inclusion of an instruction practice program. The goal of the study was to evaluate the performance of instructors who completed the course.

Congenital brain tumor: Fetal case of congenital germ cell intracranial tumor.

pos may be one of the causes of abdominal cystic masses and urinary tract obstruction. In the present case, no remarkable findings were obtained on prenatal ultrasound. Hymenectomy is widely accepted as the surgical treatment for IH, but asymptomatic IH may open spontaneously, and, if required, can be managed conservatively, without early surgical intervention. Kahn et al. followed up two patients with uncomplicated IH who were managed conservatively. These children were 1 day and 1 month old at the time of diagnosis, and spontaneous opening of the IH occurred at 8 days and 1 year, respectively. With this approach, the risk of anesthesia for asymptomatic children can be avoided. For unresolved cases of uncomplicated IH, intervention is indicated before the onset of menarche, but hymenectomy should be performed immediately in symptomatic IH patients suffering from infection or urinary tract obstruction. Urethral catheterization under ultrasound guidance is a possible option for diagnosis and initial symptom reduction; this method can be safely and effectively used in obstructive uropathy with hydrometrocolpos, as observed in the present study. Imperforate hymen is always an isolated finding. It has been observed to be accompanied, however, by malformations such as polydactyly, duplication of the ureter, ectopic ureter, urethral membrane, imperforate anus, hypoplastic or multicystic dysplastic kidney, and bifid clitoris. McKusick-Kaufman syndrome is a rare autosomal recessive syndrome mapped to 20p12 and is characterized by hydrometrocolpos, polydactyly, and congenital heart defects. Bardet-Biedl syndrome is a generic name for a heterogeneous group of autosomal recessive disorders caused by mutations in at least four loci: 16q13-q22, 11q13, 3p11-p13, and 15q22. It is characterized by retinal dystrophy or retinitis pigmentosa, post-axial polydactyly, obesity, renal dysfunction, and mental disturbances or mental retardation. In conclusion, we observed a rare case in which obstructive uropathy caused hydrometrocolpos. Thus, distension of the uterus can cause hydronephrosis and ischuria. We think that hydrometrocolpos should be considered in the differential diagnosis of ischuria in neonates and in early infants. Venous dilatation in the inguinal region can be caused by compression of the iliac venule; intrapelvic visual imaging should be performed immediately in such cases.