ABSTRACT. The viability limit defined by the Japanese Eugenic Protection Act was amended from 24 to 22 completed weeks of gestation in 1991. To testify if the amendment is appropriate, we conducted a survey on the mortality and morbidity rates of infants less than 600 g born in Japan between 1984 to 1993.Questionnaires were mailed to 205 hospitals with neonatal intensive care units (NICUs) and 165 (80%) responded. Of 1655 infants <600 g birth weight and admitted to the NICUs included in this survey, 457 (28%) survived to hospital discharge. The survival rates of infants born <24 weeks and м24 weeks of gestation were 17% (128/748) and 36% (329/903), respectively; and of infants <500 g and 500 to 599 g at birth were 16% (82/510) and 32% (375/1145), respectively. None of the infants Ϲ20 weeks of gestational age and Ϲ350 g at birth survived, but 4% (2/49), 12% (27/218), 21% (99/474), and 34% (131/ 381) born at 21, 22, 23, and 24 weeks of gestation survived, respectively. The majority (68%) died within 1 week after birth and only 10% died after the neonatal period. The main causes of death were: acute respiratory failure (33%), intraventricular hemorrhage (20%), infection (16%), and heart failure (10%). Of 457 survivors, 65% were free from handicaps. The incidence of mental retardation (DQ < 70), visual disturbance, and CP were 15%, 14%, and 11%, respectively.Admission of micropremies to NICU increased markedly after the amendment of the Eugenic Protection Act, despite a marked decline in birth rate. The survival rate increased from 22% to 33% after generalized use of surfactant in 1988, but the handicap rate (35%) among survivors remained unchanged. The new viability limit of 22 complete weeks of gestation was feasible, since survival of less than 22 weeks was exceptional while survival of 22 to 23 weeks was 18%. Pediatrics 1997;99(6). URL: http://www.pediatrics.org/cgi/content/full/99/6/e7; neonate, morbidity, mortality, extremely low birth weight infants

ABSTRAa. The plethysmo time interval (PTI) is the time interval between the beginning of QRS complex on ECG and the upstroke of the pulse wave on the plethysmogram as measured by a pulse oximeter. We examined whether measuring the PTI has clinical value for evaluating neonatal peripheral circulation. We correlated PTI values and measured, from the hand and foot, height and body weight of 14 neonates. PTI was strongly correlated with height (R2 = 0.85) and body weight (RZ = 0.78). Height was especially highly correlated, because PTI is principally affected by the distance from the heart to the measured site. We also measured PTI on three clinical cases (patent ductus arteriosus, hypovolemia, and persistent pulmonary hypertension of the newborn). PTI was shortened in cases of peripheral circulatory impairments, because pulse wave velocities increased due to the contraction of arterioles. We conclude that the PTI can evaluate the peripheral circulatory status of the neonate by applying a new principle of pulse oximeter that is widely used in neonatal intensive care units. (Pediatr Res 33: 653-657, 1993) Abbreviations PTI, plethysmo time interval PDA, patent ductus arteriosus PPHN, persistent pulmonary hypertension of the newborn EMI. electric mechanical intervalIn current neonatal intensive care units, very tiny infants who have very fragile skin are covered with many monitoring devices. We are attempting to minimize the number of monitors by expanding functions of the most commonly used monitoring device, the pulse oximeter, to detect changes of peripheral circulation on the neonate. This effort is v r o m~t e d bv our belief that changes in peripheral circulation are-an exireme& important sign of first manifestation of deterioration of the neonate.If we could evaluate peripheral circulation objectively, we could manage many diseases at an earlier stage than current devices could detect. Currently, however, no devices are available to monitor peripheral circulation of the neonate noninvasively and continuously.The plethysmography of the pulse oximeter expresses changes in arteriolar blood volume (1, 2). Moreover, the pulse wave velocity increases concurrently with reflex contraction of arterioles (3). Therefore, we examined whether the PTI, the pulse wave conduction time, has clinical value for evaluating the neonatal peripheral circulation.with height and body weight, of neonates. Fourteen neonates, born at 23 to 39 wk of gestation, and weighing 523 to 2925 g at birth, were enrolled into the study. PTI are measured in a stable state (mean, d 20). Postconceptional ages at the time of measurement were 25 to 39 wk. Method. By using a pulse oximeter (Nellcor N-200) and an electrocardiogram monitor, ECG and pulse wave plethysmogram were recorded synchronously by a MacLab system (ADI, Ltd., Castle Hill, Australia). The PTI was measured on a composite graph of ECG and the plethysmogram from the pulse oximeter as shown in Figure 1. PTI was assessed as the time interval between the beginning of QRS complex on ECG and t...

No abstract

We herein report two cases of thrombotic thrombocytopenic purpura (TTP) complicated by other autoimmune disorders, autoimmune hepatitis and immune thrombocytopenia, respectively. In both cases, corticosteroids were continuously administered for the treatment of preceding autoimmune disorders. However, a sufficient objective response for TTP was not obtained by plasma exchange and corticosteroid treatment. Once a week rituximab (375 mg/m 2 ) treatment for 4 times was initiated within 2 weeks from the diagnosis. Both patients achieved a sufficient response, and have never had any recurrence as of the last follow-up dates. The early introduction of rituximab could be an effective treatment option in TTP patients complicated with other autoimmune disorders.

Congenital cholesteatoma is typically an expanding cystic mass of keratinizing squamous epithelium located medial to the intact tympanic membrane in patients with no prior history of perforation, otorrhea and ear. It is generally thought to be a progressive disease and is usually surgically removed upon detection as the first-choice treatment. As such, it is rare to be observed for a long term without progression. Here we report a rare case of congenital cholesteatoma that remained in an undetectable size and did not deteriorate mild hearing loss for 12 years. A seven years old boy was referred to us with right hearing impairment. Pure-tone audiometry found conductive hearing loss with an air-bone gap of 25 dB and a high-resolution computed tomography (CT) scan found the eroded long process of incus but did not detect any soft tissue density indicating congenital cholesteatoma. He initially did not wish to undergo surgery. His hearing level and image finding remained virtually unchanged during the next 12 years of the follow-up period. Twelve years later, endoscopic ear surgery was performed, which revealed a very small cholesteatoma mass, an eroded long process of the incus and ossicular chain discontinuities. We suspect that the cholesteatoma was originally larger, partially eroded the incus, then regressed to a very small size, and remained small for at least 12 years under our observation.