Seiji Yoshimoto

Time-course effect of a single dose of hydrocortisone for refractory hypotension in preterm infants.

Background:  The aim of this study was to determine the time‐course effect of a single dose of hydrocortisone (HC) on arterial blood pressure in extremely low gestational age newborns (ELGAN) with refractory hypotension during the first 3 days of life.

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.

Familial Hemophagocytic Lymphohistiocytosis Presenting as Hydrops Fetalis.

Background Familial hemophagocytic lymphohistiocytosis (FLH) is an autosomal recessive disorder of immune regulation that leads to a hyperinflammatory syndrome. Fetal onset FHL is extremely rare and is considered to be the most severe form of FHL. Case We report a preterm case of FHL that presented as hydrops fetalis. The infant was treated with a chemotherapy regimen based on the HLH-2004 protocol from the third day of life. However, he had persistent cytopenia and died on the 18th day of life due to bacteremia. The detection of defective perforin expression in the patients natural killer cells and mutations in the PRF1 gene resulted in a molecular diagnosis of FHL. Conclusion We suggest that early diagnosis and the development of an appropriate immunosuppressive strategy that can induce and maintain remission until hematopoietic stem cell transplantation can be performed are required to improve the outcomes of fetal onset FHL.

Three-Dimensional Computed Tomographic Findings of Bridging Bronchus with Pulmonary Artery Compression

Afemale infant was born at 40 weeks gestation with a birth weight of 3040 g. At 4 hours after birth, she was admitted and intubated for respiratory distress. Chest radiograph showed a shift of the mediastinal structures to the right. Echocardiography showed no major heart malformation. She was successfully extubated after 17 hours of mechanical ventilation, but mild inspiratory stridor still continued. Three-dimensional computed tomography demonstrated bridging bronchus (BB) with pulmonary artery compression (Figure). The infant was discharged on the 21st day after birth. Since the age of 15 months, she has been hospitalized several times with bronchitis; however, she has not required surgical intervention for airway obstruction. BB is an extremely rare bronchial branching anomaly. 1-3 Three-dimensional computed tomography is a powerful means for demonstrating the special relationships of arterial and tracheal anomalies. n

Trisomy 8 mosaicism with pyloric atresia and situs ambiguous

A 2544 g male neonate was born at 35 weeks 4 days’ gestation to a 28-year-old, gravida 3, para 2 mother via elective cesarean section. She did not take any medications during pregnancy. The mother was transferred to Hyogo Prefectural Kobe Children’s Hospital Perinatal Center due to polyhydramnios and fetal Correspondence: Sota Iwatani, MD, Department of Neonatology, Hyogo Prefectural Kobe Children’s Hospital Perinatal Center, 1-1-1 Takakuradai, Suma-Ku, Kobe, Hyogo 654-0081, Japan. Email: iwatani_kch@hp.pref.hyogo.jp Received 31 March 2014; revised 15 July 2014; accepted 2 September 2014. a b

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.