BACKGROUND:Clarifying clinical features of critically ill pediatric patients is essential for optimizing the regional emergency care system. However, the relationships between hospital case volume, interhospital transfer, and outcomes, including causes of death, remain unclear. METHODS:An observational study was conducted using prospectively collected data on critically ill patients aged 15 years or younger. Patients enrolled in this study were those who met the criteria for emergency and critical care unit management in Fukuoka Prefecture, Japan, from June 2014 to May 2019. Data on etiologic categories, outcomes, interhospital transfer, and use of intensive care interventions were collected. Hospitals were classified according to patient volume (high-volume: ≥ 100 and low-volume: < 100 patients during the observation period). RESULTS:Among 3124 patients, 891 (28.5%) were infants (< 1 year). The annual incidence was 0.85 per 1000 children. Endogenous, exogenous, and "undetermined" etiologies accounted for 2481 (79.4%), 495 (15.8%), and 148 (4.7%) patients, respectively. Of 327 deaths (10.5%), 157 (48.0%) occurred in infants, and 89 (56.7%) of infant deaths were classified as "undetermined". In-hospital mortality among admitted patients was higher in low-volume hospitals (8.7% vs. 5.3%, p < 0.01), as was the proportion of "undetermined" deaths (49.5% vs. 28.8%, p < 0.01). Transferred patients had higher ICU admission rates (62.5% vs. 52.6%, p < 0.01), without higher mortality among admitted patients. CONCLUSIONS:Critically ill infants had high mortality, and many deaths remained undetermined. These findings highlight the need to strengthen regional transport systems and postmortem evaluation in pediatric emergency care.
BACKGROUND:Mycoplasma pneumoniae is a leading cause of pediatric community-acquired pneumonia. Macrolide-resistant M. pneumoniae (MRMP) emerged in East Asia in the 2000s and was once highly prevalent in Japan. However, its epidemiology in Japan following the coronavirus disease 2019 (COVID-19) pandemic is unclear. METHODS:The present, single-center, retrospective study, conducted at a tertiary children's hospital in Tokyo, investigated the post-pandemic prevalence of MRMP and compared the clinical features of MRMP and macrolide-susceptible M. pneumoniae (MSMP). Patients aged ≤ 18 years who were positive for M. pneumoniae on polymerase chain reaction (PCR) between April 2020 and March 2025 were enrolled. MRMP was defined by macrolide-resistance mutations detected using a point-of-care, PCR-based assay. The proportion of patients with MRMP and the clinical characteristics of the MRMP and MSMP cohorts were analyzed. RESULTS:In total, 272 patients had a M. pneumoniae infection, and 191 (70.2%) patients were classified into the MRMP group. A marked resurgence of M. pneumoniae infections, of which MRMP comprised 87% of the cases, was observed in April 2024 and peaked in October 2024. Among hospitalized patient (52/272, 19.1%), MRMP group were more likely to require oxygen (89% vs. 43%, p = 0.0015), and experience respiratory complications (47% vs. 7.1%, p = 0.019) than MSMP group. CONCLUSION:MRMP reemerged as the predominant strain in Tokyo following the COVID-19 pandemic and may be associated with greater severity and recalcitrance to treatment. Therefore, monitoring its prevalence and adjusting the antibiotic strategy are crucial.
BACKGROUND:Few studies have focused on the respiratory management after slide tracheoplasty. This study aimed to evaluate the effect of high-flow nasal cannula (HFNC) compared with conventional therapy in preventing reintubation after slide tracheoplasty. METHODS:This was a retrospective study conducted at a single center, the Department of Pediatric Surgery. The medical records of 68 patients who had undergone slide tracheoplasty for congenital tracheal stenosis (CTS) before the age of 2 years from February 2012 to September 2021 were included. Patients were divided into group C (conventional therapy) or H (HFNC therapy), based on whether conventional oxygen therapy and positive pressure ventilation or HFNC was used after withdrawal from the ventilator, respectively. RESULTS:There were no significant differences in the postoperative reintubation rate and ventilator dependency between groups C and H. There were no HFNC complications. CONCLUSIONS:The use of postoperative HFNC is not inferior to noninvasive ventilation in terms of therapeutic efficacy. HFNC can be used without complications for a limited time after extubation.
BACKGROUND:Chronic lung disease (CLD), commonly recognized as bronchopulmonary dysplasia and primarily associated with prematurity and low birth weight, is designated as a specified chronic pediatric disease in Japan. However, the characteristics of children registered in the National Database of Specified Chronic Pediatric Diseases have not been fully elucidated. METHODS:With approval from the Ethics Committee of Saitama Medical Center, Saitama Medical University, and the Third-Party Data Provision Office for Patients with Intractable Diseases, we analyzed data from Medical Certificates of Specific Chronic Pediatric Diseases for patients with CLD registered between January 2015 and March 2023. RESULTS:A total of 1737 patients with CLD were identified. Extremely preterm infants and term infants accounted for 47% and 24% of cases, respectively, with marked regional variation in gestational age distribution. Among 410 registered term infants, neurological disorders (43%) and chromosomal abnormalities (19%) were the most common underlying conditions. With increasing age, the proportion of extremely preterm infants decreased, whereas that of term infants increased. In a subgroup analysis of 805 extremely preterm infants, invasive mechanical ventilation at 36 weeks' postmenstrual age was independently associated with persistent registration within the chronic disease support program (odds ratio 3.16, 95% CI 1.81-5.52; p < 0.001). CONCLUSIONS:This nationwide registry study demonstrates that registry-defined CLD in Japan represents a heterogeneous population, including a substantial number of term infants with diverse comorbidities. Among extremely preterm infants, the need for invasive respiratory support at 36 weeks' postmenstrual age was associated with persistent registration within the chronic disease support program, underscoring the importance of optimizing long-term management strategies.
BACKGROUND:Valproic acid (VPA) and levetiracetam (LEV) are among the most widely used anti-seizure medications (ASMs) in pediatric epilepsy. Although they share the common goal of seizure control, these drugs exhibit distinct pharmacokinetic characteristics, which can influence therapeutic drug monitoring (TDM), dosing strategies, and treatment response. OBJECTIVE:This study aims to compare the intra-drug pharmacokinetic profiles of VPA and LEV in pediatric patients, focusing on dose-normalized concentration (C0/mg/kg). The study also investigates the impact of concomitant enzyme-inducing or enzyme-inhibiting drugs on these parameters. METHODS:The analysis included 1141 serum samples from 817 patients (447 VPA; 370 LEV). Pediatric patients receiving monotherapy or combination therapy with one of two anti-seizure medications were retrospectively analyzed. Pharmacokinetic indices were compared using descriptive and nonparametric methods. Subgroup analysis was performed according to concomitant drugs affecting liver metabolism. RESULTS:A moderately positive correlation was observed between daily LEV dose and serum concentration (r = 0.47, p < 0.0001), while VPA showed a weaker but significant dose-concentration relationship (r = 0.31, p < 0.001; R2 = 0.096). Dose-normalized minimum concentrations (C0/mg/kg) differed significantly between treatment groups for both drugs. In the VPA group, concomitant use of enzyme inducers was associated with significantly lower C0/mg/kg values compared with both monotherapy and neutral co-medication groups (p < 0.001). Similarly, the LEV+ inducer group showed significantly different C0/mg/kg values than levetiracetam monotherapy (p = 0.005). Neutral concomitant drugs did not significantly affect C0/mg/kg for either drug. CONCLUSION:Concomitant enzyme-inducing ASM significantly reduced dose-normalized trough concentrations of VPA and LEV, while neutral co-medications had no effect, highlighting the importance of TDM in pediatric combination therapy.
BACKGROUND:Nebulizer therapy frequently provokes fear and anxiety in young children, reducing treatment compliance. Although therapeutic play reduces procedural distress in various settings, its use during pediatric emergency nebulization has not been sufficiently investigated. METHODS:This pretest-posttest control group study allocated 102 children (5-8 years) to intervention (n = 51) or control (n = 51). The intervention group received 10-15 min of therapeutic play (toy, mask, stickers) before nebulization; controls received routine care. Outcomes were fear (Children's Fear Scale), anxiety (Children's State Anxiety Scale), and treatment compliance (Pediatric Nebulizer Therapy Follow-up Questionnaire). Data were analyzed using independent samples t-tests, Mann-Whitney U tests, and chi-square tests; effect sizes were calculated with Cohen's d. RESULTS:The therapeutic play group showed significantly lower fear (parent: p < 0.001, d = 0.97; child: p < 0.001, d = 0.91) and higher treatment compliance (p < 0.001) than controls. Parent-reported anxiety was lower (p = 0.005, d = 0.58); child-reported anxiety did not differ significantly. CONCLUSIONS:A brief therapeutic play session before emergency nebulization significantly reduces fear and improves treatment compliance. This low-cost intervention should be integrated into pediatric emergency care.
BACKGROUND:In recent years, self-administered adrenaline therapies have expanded beyond conventional injectable formulations with the development of intranasal formulations, increasing the range of available delivery devices. This study aimed to clarify which factors are prioritized by parents or guardians of children carrying adrenaline auto-injectors and how they perceive different adrenaline delivery devices. METHODS:A questionnaire-based survey was conducted from April to October 2025 among parents or guardians of children prescribed adrenaline auto-injectors. The survey assessed factors considered important in adrenaline formulations, including certainty of effectiveness, ease of administration, pain during administration, portability, and caregiver concerns. RESULTS:A total of 98 respondents were included in the analysis. The most highly prioritized factor for adrenaline self-administration was certainty of effectiveness, followed by ease of administration and portability. Regarding device selection, when no information about the formulations was provided, the highest proportion of respondents answered that they were "unable to decide". In a hypothetical scenario assuming equivalent efficacy of the two formulations, parents or guardians tended to prefer the intranasal device. CONCLUSION:Parents or guardians prioritized certainty of effectiveness when selecting adrenaline self-administration devices. Many respondents were unable to decide between injectable and intranasal devices when no information was provided, whereas preference shifted toward intranasal adrenaline in a hypothetical scenario assuming equivalent effectiveness. These findings suggest that evidence-based information sharing and device-specific education are important when introducing new adrenaline delivery options.
BACKGROUND:Rapid glucose assessment is essential in neonatal intensive care units (NICUs) for early detection of hypoglycemia. We evaluated the agreement between neonatal blood glucose levels measured using bedside blood gas analyzers (GasBS) and those measured in the central laboratory (LabBS), and identified factors associated with clinically significant discrepancies. METHODS:We retrospectively analyzed 5436 paired specimens from 2105 infants admitted to the NICU. For the primary agreement analyses, 5375 specimens with GasBS > 20 mg/dL were included. Agreement between GasBS and LabBS was assessed using Bland-Altman analysis, correlation analysis, and linear mixed models. Factors associated with clinically significant discrepancies (absolute difference ≥ 10 mg/dL) were evaluated using generalized linear mixed models. Exploratory receiver operating characteristic analysis was performed to assess the ability of GasBS to detect LabBS < 40 mg/dL. RESULTS:GasBS and LabBS showed good agreement, with a mean difference of 1.88 mg/dL (95% limits of agreement, -12.56 to 16.32 mg/dL) and a strong correlation (Spearman's ρ = 0.939, p < 0.001). Lower base excess, lower oxygenated hemoglobin, and higher postnatal age were associated with greater discrepancies, whereas higher hematocrit was associated with an increased risk of clinically significant discrepancies. GasBS also showed excellent performance in detecting LabBS < 40 mg/dL, with an area under the receiver operating characteristic curve of 0.985 and an optimal cutoff of 43.5 mg/dL. CONCLUSIONS:Blood gas analyzers provide clinically useful glucose measurements in newborns. However, discrepancies from central laboratory measurements may occur under certain physiological conditions, and confirmatory testing remains essential when severe hypoglycemia is suspected.
BACKGROUND:Sleep disturbances are among the most burdensome consequences of atopic dermatitis (AD), yet data on infant sleep and its impact on parental sleep quality remain limited. To evaluate sleep characteristics in infants with AD, assess parental sleep quality, and investigate the associations between disease severity, infant sleep disturbances, and parental sleep outcomes. METHODS:In this controlled cross-sectional study, 55 infants aged 3-36 months with AD and 60 age-matched healthy controls were enrolled. Disease severity was assessed using the SCORAD index. Infant sleep was evaluated with the Brief Infant Sleep Questionnaire-Revised (BISQ-R), and parental sleep quality with the Pittsburgh Sleep Quality Index (PSQI). Multivariable logistic regression was performed to identify factors independently associated with infant and parental sleep impairment. RESULTS:Compared with healthy controls, infants with AD had significantly shorter nighttime sleep duration, longer nighttime wakefulness, and a higher prevalence of poor sleeper status (56.4% vs. 30.0%, p = 0.004). Parents of infants with AD had significantly higher global PSQI scores and a greater prevalence of poor sleep quality (50.9% vs. 28.3%, p = 0.013). Poor sleeper status was strongly associated with poor parental sleep quality (p < 0.001). Increasing SCORAD scores independently predicted both infant sleep impairment (OR = 1.06, 95% CI 1.01-1.11) and poor parental sleep quality (OR = 1.07, 95% CI 1.01-1.12). CONCLUSIONS:AD is associated with significant impairment of both infant and parental sleep, with sleep disturbances becoming more pronounced as disease severity increases. The close relationship between infant and parental sleep highlights the importance of incorporating routine sleep assessment into the family-centered clinical management of infants with AD.
BACKGROUND:Whole-exome sequencing (WES) is increasingly used in pediatric diagnostics, yet families often struggle to understand its complexity and implications. Educational resources that facilitate informed decision-making are essential in genomic medicine. This study aimed to develop and evaluate an animated educational video and accompanying booklet to support families considering WES for children with suspected genetic conditions in Japan. METHODS:The materials were designed according to the International Patient Decision Aid Standards and informed by prior studies. The alpha version was reviewed by clinical genetics professionals and patient advocates (n = 31), and revised based on their feedback. The beta version was subsequently evaluated by parents of children with congenital or genetic disorders (n = 23). RESULTS:Stakeholders' feedback improved the accuracy, clarity, and structure of the materials. Parents rated the video as easy to understand, useful, and appropriately paced. Open-ended comments highlighted its potential value in facilitating discussion during clinical visits. CONCLUSIONS:This is the first animated educational tool on WES to be developed in Japan. The video and booklet may enhance family understanding, support psychosocial dialogue in genetic counseling, and promote value-based decision-making. Broader implementation could contribute to more consistent and equitable communication about WES in pediatric care settings.
BACKGROUND:Prompt and accurate diagnosis of testicular torsion (TT) is essential to prevent irreversible testicular damage and to preserve fertility in pediatric cases of acute scrotum. Ultrasonography combined with color Doppler imaging is considered the first-line diagnostic modality for suspected TT. However, TT cannot be ruled out solely by demonstrating altered blood flow in the testicular vasculature. This study retrospectively analyzed cases of acute scrotum managed in our department with a focus on identifying the relevant diagnostic factors of TT. METHODS:We conducted a retrospective analysis of TT in non-neonatal patients who were hospitalized and treated at our department between January 2013 and November 2024. Patient age, chief complaints, and blood test findings, including white blood cell (WBC) count and C-reactive protein (CRP) levels, were analyzed. RESULTS:76 cases of non-neonatal acute scrotum patients were conducted to identify accurate diagnostic factors for TT, in addition to ultrasonographic examination. The results showed that TT was significantly associated with patients ≥ 11 years of age (p = 0.022) and extragenital symptoms, such as groin or lower abdominal pain (p < 0.001). An elevated WBC count (≥ 10,100/μL) was identified as a strong predictor (p < 0.001), whereas CRP level showed no diagnostic significance. A multivariate logistic regression analysis confirmed that age and WBC count were independent predictors. CONCLUSION:In addition to ultrasonography, consideration of patient age and WBC count may improve the diagnostic accuracy of TT. We intend to continue to accumulate more cases and conduct further investigations in the future.
