Aims Critical congenital heart disease (CCHD) requires surgery or catheter intervention within the first year of life; delayed diagnoses result in worsened outcomes. In Japan, there are few reports of delayed CCHD diagnosis. We investigated the diagnoses and factors associated with the late detection of CCHD. Methods This retrospective cohort study evaluated 88 CCHD infants admitted to a level IV facility. We compared the late detection rates across facility levels of neonatal care and CCHD characteristics. Results Critical congenital heart disease was identified prenatally in 46 (52%) infants: early (≤3 days postnatally) in 29 (33%) and late (≥4 days postnatally) in 13 (15%). The oxygen saturation of 27 of 29 infants with early detection and 7 of 13 infants with late detection was measured using pulse oximetry within 3 days postnatally. Factors associated with the late detection of CCHD were lack of clinical recognition of symptoms in five infants, referral to higher‐level facilities after discharge in four infants, and definitive diagnosis not confirmed using echocardiography in four infants. The most common factors associated with late detection were referral to higher‐level facilities after discharge in level I facilities and definitive diagnosis not confirmed using echocardiography in level II facilities. Conclusion Critical congenital heart disease may require advanced knowledge and echocardiographic techniques for diagnosis. Pulse oximetry and telemedicine should also be incorporated in the diagnostic algorithm. Improvement in these factors might contribute to reducing the late detection of CCHD.

Aim: This study investigated factors that can predict chromosomal abnormalities in pregnant women with polyhydramnios. The ability of prenatal factors to predict chromosomal abnormalities was evaluated using receiver operator characteristic curves.Methods: Of 76 eligible pregnant women, major anomalies were detected in 41 (54%) and chromosomal abnormalities in 19 (25%): trisomy 13 in one, trisomy 18 in 10, trisomy 21 in seven, and 22q11.2 deletion syndrome in one. Combined factor scores, including maternal age, major anomaly, abdominal circumference percentile, femur length percentile, and estimated fetal weight percentile, proved to be good predictors (area under the curve, 0.81-0.87) of chromosomal abnormalities and showed a sensitivity of 79% and specificity of 75%.Conclusion: Combined scores demonstrated more accuracy than individual factors for predicting chromosomal abnormalities. Even if an anomaly is not detected on fetal ultrasonography, in cases with higher scores, chromosomal abnormalities should be suspected, and delivery at a level III facility may be recommended.

Chylothorax is a critical complication after surgery for congenital heart disease, which markedly compromises the postoperative course with increased mortality. As the cardiovascular load additively causes stagnation of the thoracic duct, chylothorax after palliative cardiac surgery can be highly refractory to the therapies. Here we report a case of two patients with refractory chylothorax attributed to hemodynamic load which was successfully treated with minocycline pleurodesis. In combination with congenital heart disease, extremely low birth weight coupled with prematurity in case 1 and venous obstruction with excessive volume load due to additional aortopulmonary shunt in case 2 additively increased resistance to the therapies, including fasting with total parenteral nutrition (TPN), XIII factor supplementation, octreotide infusion, as well as the use of steroids. As pleural effusion was sustained at more than 50 ml/kg/day, the condition of both patients deteriorated severely; pleurodesis using minocycline was urgently introduced. Pleural effusion declined at every session and both cases were in remission in a few sessions without unfavorable acute reaction. No symptoms suspecting chronic adverse effects were observed during follow-up, including respiratory dysfunction, pulmonary hypertension, tooth staining, or abnormal bone mineralization. Although the application of minocycline for children should be minimized, minocycline pleurodesis can be an option for patients with refractory and life-threatening chylothorax.

Background Overnight catheter drainage (OCD) is introduced to avoid overdistention of the bladder at night‐time when clean intermittent catheterization proves ineffective for daytime management of neurogenic bladder. We adopted OCD using disposable silicone no‐balloon (DSnB) catheters, with the distal end outside the body opening into diapers. OCD using DSnB catheter, however, had risks of retrograde bacterial contamination. Therefore, in this study, the validity of equipping DSnB catheters with check valves to prevent retrograde bacterial contamination was examined. Methods For the in vitro study, excised saline‐filled swine bladders were drained using DSnB catheters with or without check valves, and the time required for intravesical pressure to reach 5 cmH2O was measured. For the in vivo study, in cross‐over experiments comparing DSnB catheters with and without check valves, OCD using DSnB catheters for 10 h was performed in rabbits under analgesia. Bacterial growth from urine samples before and after OCD and residual urine volume were examined. Results For the in vitro experiment, the median drainage time was 368.2 s (range, 88–1,085 s) and 344.7 s (range, 28–840 s) with and without check valves, respectively (n = 6), which was not significantly different. For the in vivo experiment, in cross‐over experiments (n = 8) new bacterial growth rates after OCD did not differ, and median residual urine volume was 17.1 mL (range, 0–75 mL) and 1.2 mL (range, 0–5 mL) with and without check valves, respectively (P = 0.055). Conclusions Installing a check valve in the DSnB catheter did not decrease new bacterial growth, while tending to increase residual urine volume. DSnB catheters without check valves appear to be better for continuous drainage of urine from bladder.