感染性動脈瘤はmodified Blalock–Taussig（mBT）シャント造設後に発症する稀な合併症である．致死的な経過を辿ることもあり迅速な治療が必要であるが画一した治療方法はない．今回mBTシャント術後に発症した感染性動脈瘤に対しカテーテル手技とのハイブリッド手技により安全に外科的治療を行えた症例を報告する．症例はファロー四徴症に対し左mBTシャント術後の5か月男児で，低酸素血症を主訴に来院し造影CT検査にてシャント位置に動脈瘤を認めた．また血液培養検査でStaphylococcus capitis陽性であり同菌による感染性動脈瘤が疑われた．抗生剤加療のみでは治療難渋し，感染巣の摘出が必要と考えた．胸骨正中切開の際に動脈瘤破裂や出血のリスクがあるため動脈瘤への流入血管でバルーン留置行い，完全に血流を遮断したうえで動脈瘤の摘出を行った．また同時に新規肺血流確保のため右室流出路再建を施行し術後56日に退院した．感染性動脈瘤に対するハイブリッド手技は補助治療として有力である．

A number of studies have been made on the sleep characteristics of children born preterm in an attempt to develop methods to address the sleep problems commonly observed among such children. However, the reported sleep characteristics from these studies vary depending on the observation methods used, i.e., actigraphy, polysomnography and questionnaire. In the current study, to obtain reliable data on the sleep characteristics of preterm-born children, we investigated the difference in sleep properties between 97 preterm and 97 term toddlers of approximately 1.5 years of age using actigraphy. Actigraphy units were attached to the toddlers' waists with an adjustable elastic belt for 7 consecutive days, and a child sleep diary was completed by their parents. In the study, we found that preterm toddlers had more nocturnal awakenings and more daytime activity, suggesting that preterm-born children may have a different process of sleep development in their early development.

Toxic epidermal necrolysis (TEN) is a life-threatening cutaneous reaction that presents with extensive erythema and epidermal diffuse exfoliation of >30% of the body surface area (BSA). Although TEN has high mortality and morbidity rates, few pediatric TEN studies have been conducted because of its rarity. We report a pediatric case of acetaminophen-induced TEN. The patient recovered without complications. A previously healthy 16-month-old boy was treated for acute encephalopathy. He had no history of drug allergy. During encephalopathy treatment, he received multiple drugs. (e.g., ceftriaxone, ampicillin sulbactam, fosphenytoin, phenobarbital, acetaminophen, midazolam, thiopental, methylprednisolone, dexamethasone, immunoglobulin, famotidine, edaravone, vitamins, mannitol, yigansan, lactobacillus, and triclofos sodium). Seventeen days after admission, small erythema appeared on his forearms and lower legs. A drug reaction to phenobarbital was suspected, so this drug was replaced with levetiracetam. One day later, he developed a fever of 40.0 °C, blisters in the mouth, and exanthematous lesions all over his body (Fig. 1a). Laboratory investigations showed no significant abnormalities. Prednisolone treatment (PSL; 2 mg/kg/day) was administered and all other medications were withdrawn because of suspected Stevens–Johnson syndrome (SJS). Despite treatment, the lesions progressed rapidly to epidermal detachment, covering >30% of the BSA, and Nikolsky’s sign was positive. TEN was diagnosed, and methylprednisolone pulse therapy (mPSL; 30 mg/kg/day for 3 days) and intravenous immunoglobulin (IVIG; 400 mg/kg/ day for 5 days) were administered three days after eruption onset. The patient’s fever was sustained, and his skin lesions worsened for the first four days (Fig. 1b). Epidermal detachment of >50% of his BSA, including the entire face, trunk, and extremities, mucosal erosion, and conjunctival hyperemia, was observed. Consequently, he was moved to the intensive care unit (ICU). Critical care management included consultations from dermatology, emergency, and wound care. Intubation was unnecessary. He received fluid resuscitation using the Parkland burn formula after wound evaluation. Monitoring of vital signs and urine output was continued until his condition stabilized. Pain-control medications were administered following assessment. He was sedated to reduce anxiety. Wounds were cleansed daily with soap and water, and genital lesions were cleansed at each diaper change. Dimethyl isopropyl azulene ointment was then applied and covered with non-adherent dressings (Fig. 1f). Feeding occurred via a nasoenteral tube. An ophthalmologist monitored the ocular surface inflammation every two days during the acute phase. No corneal epithelial disorders were detected. On day 8 postonset, methicillin-resistant coagulase-negative staphylococcal bacteremia was identified. Vancomycin had been initiated in advance, and the bacteremia did not cause any associated adverse events. Two weeks post-onset, the skin had healed remarkably (Fig. 1c–e). He did not develop any respiratory or gastrointestinal complications. He was discharged without complications after 28 days, including 10 days in the ICU. Drug lymphocyte stimulation tests (DLST) were performed for phenobarbital, levetiracetam, and acetaminophen. Stimulation indexes (<1.6: negative, >1.6 but <1.8: false positive, >1.8: positive) were 1.2 for phenobarbital, 1.4 for levetiracetam, and 3.7 for acetaminophen. Toxic epidermal necrolysis is a rare and serious skin reaction caused mostly by drugs. Antiepileptics and antibiotics are responsible for most pediatric cases; however, other drugs, such as non-steroidal anti-inflammatory drugs (NSAIDS) and acetaminophen can be causative. The algorithm of drug causality for epidermal necrolysis (ALDEN) is a useful reference tool to deduce the likely culprit drug without examinations. Based on ALDEN scores, phenobarbital was evaluated as “very probable,” whereas acetaminophen was evaluated as “unlikely” for our case. However, DLST results indicate acetaminophen as the causative drug. Genetic analysis is also valuable for evaluating drug reaction risk. HLA-A*02:06, HLA-B*44:03, HLA-B*13:01, and HLAC*14:03 were reported in Japanese as being associated with acetaminophen-induced SJS/TEN. We assessed the HLA alleles of our patient, but none of these alleles was detected, nor was any that have been reported as related to antiepileptics. Correspondence: Ayumi Kunikata, MD, Department of Pediatrics, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya, Tokyo, 150-8935, Japan. Email: ayumih4m13@gmail.com Received 9 April 2020; revised 25 June 2020; accepted 2 July 2020. doi: 10.1111/ped.14379

Our recent study on full-term toddlers demonstrated that daytime nap properties affect the distribution ratio between nap and nighttime sleep duration in total sleep time but does not affect the overall total amount of daily sleep time. However, there is still no clear scientific consensus as to whether the ratio between naps and nighttime sleep or just daily total sleep duration itself is more important for healthy child development. In the current study, to gain an answer to this question, we examined the relationship between the sleep properties and the cognitive development of toddlers born prematurely using actigraphy and the Kyoto scale of psychological development (KSPD) test. 101 premature toddlers of approximately 1.5 years of age were recruited for the study. Actigraphy units were attached to their waist with an adjustable elastic belt for 7 consecutive days and a child sleep diary was completed by their parents. In the study, we found no significant correlation between either nap or nighttime sleep duration and cognitive development of the preterm toddlers. In contrast, we found that stable daily wake time was significantly associated with better cognitive development, suggesting that sleep regulation may contribute to the brain maturation of preterm toddlers.

The purpose of the present study is to examine the association between toddlers' sleep arrangements and their nighttime sleep duration and other sleep variables. For this investigation, we performed a study in which child activity and sleep levels were recorded using actigraphy. The parents of 1.5-year-old toddlers (n = 106) were asked to attach an actigraphy unit to their child’s waist with an adjustable elastic belt and complete a sleep diary for 7 consecutive days. Questionnaires were used to assess the sleep arrangements of the toddlers. There was a significant negative correlation between nap duration and nighttime sleep duration, suggesting that longer nap sleep induces shorter nighttime sleep duration. Among the sleep arrangements, such as nighttime breastfeeding or co-sleeping, only nighttime breastfeeding predicted shorter nighttime sleep duration. Our findings indicate that shorter naps induce a longer nighttime sleep in 1.5-year-old toddlers while nighttime breastfeeding decreases their nighttime sleep duration.

This study examined whether forced postural change from prone to supine during toddlers’ nap, a preventative measure taken in Japan for sudden unexplained death in childhood (SUDC), disturbs toddlers’ sleep. When the "Back to Sleep" campaign (BSC) was introduced to Japan in 1996, its recommendations were also applied to infants aged 1 year old and over with the expectation that the BSC recommendations may also contribute to a decrease in the occurrence rate of SUDC. Since then, Japanese nurseries have routinely conducted sleeping position checks and positional adjustments of toddlers every 5–10 min during naps. A total of 52 toddlers (age 18.4 ± 3.3 months, means ± SD) were continuously monitored for 8 h during daytime at nursery schools for wake-sleep status and body position (prone, supine and lateral) with actigraphs and 3-orthogonal-axis accelerometers. Out of the 52 toddlers, 24 toddlers adopted prone positions during naps, which were adjusted by nursery staff back to supine. When nursery staff manually changed the toddlers position from prone to supine, the toddlers either did not wake or woke only briefly (3.1 ± 4.9 min) and returned to sleep soon after the positional change. Our study indicates that manual change of toddlers’ sleeping position from prone to supine, a potential SUDC prevention method, does not disturb toddlers’ sleep during their naps.

The purpose of this study was to determine the effects of body position (prone, supine and lateral) together with sleep status (wake and sleep) on the cardiorespiratory stability of near-term infants. A total of 53 infants (gestational age at birth 33.2 ± 3.5 weeks; birth weight 1,682 ± 521 g; gestational age at recording 38.6 ± 2.1 weeks; weight at recording: 2,273 ± 393 g) were monitored for 24 hours for clinically significant apnea (>15 seconds), bradycardia (<100 bpm), and oxygen desaturation (SpO2 < 90%) in alternating body positions (prone, supine and lateral) by cardiorespiratory monitors and 3-orthogonal-axis accelerometers. Sleep status of the infants was also continuously monitored by actigraphs. No apnea was observed. During wake, severe bradycardia was most frequently observed in the lateral position while, during sleep, severe bradycardia was most frequently observed in the supine position. Desaturation was most frequently observed in the supine and lateral positions during both wake and sleep. Our study suggests that the cardiorespiratory stability of infants is significantly compromised by both body position and sleep status. During both wake and sleep, prone position induces the most stable cardiorespiratory functions of near-term infants.

We report an optical switchable light filter fabricated from all solid-state materials for use in preterm infant incubators. The nickel oxide (NiO) thin film in the filter was fabricated by magnetron sputtering. Conventional NiO thin films are often dipped in a solution to produce a nickel hydroxide thin film; however, our as-prepared film was stored in a thermostat/humidistat bath at 50 °C and 80% relative humidity to create the nickel hydroxide thin film instead, according to the electrochromic (EC) principle. The properties of the NiO thin film were also investigated. The optical switchable light filter also contained a W-Ir-O thin film, because the widely used WO3 thin film shows an unsuitable EC color change to dark blue. The W-Ir-O thin film did not absorb the longer wavelengths in the visible range, which is required for incubators. The optical switchable light filter containing the NiO thin film changed between pale yellow and dark yellow when a voltage was applied. The optical switching speed from the pale yellow to dark yellow state was around 60 s, and the reverse process was around 60 s. The fabrication of filters with a suitable color change for incubators requires further investigation.

An optical switchable light filter was fabricated from all solid-state materials of ITO/W-Ir-O/Ta2O5/NiO/ITO for use in preterm infant incubators. The materials were fabricated by magnetron sputtering. The as-prepared NiO film was stored in a thermostat/humidistat bath to create the nickel hydroxide, and its basic properties were also investigated by electrochemical and optical analysis. The filter also contained a W-Ir-O thin film, because the widely used WO3 thin film shows an unsuitable electrochromic color change to dark blue. The W-Ir-O thin film did not absorb the longer wavelengths in the visible range, which is required for incubators. The filter changed between pale yellow and dark yellow when a voltage was applied. The fabrication of filters with a suitable color change for incubators requires further investigation.

Previous studies have demonstrated that afternoon naps can have a negative effect on subsequent nighttime sleep in children. These studies have mainly been based on sleep questionnaires completed by parents. To investigate the effect of napping on such aspects of sleep quality, we performed a study in which child activity and sleep levels were recorded using actigraphy. The parents were asked to attach actigraphy units to their child's waist by an adjustable elastic belt and complete a sleep diary for 7 consecutive days. 50 healthy young toddlers of approximately 1.5 years of age were recruited. There was a significant negative correlation between nap duration and both nighttime sleep duration and sleep onset time, suggesting that long nap sleep induces short nighttime sleep duration and late sleep onset time. We also found a significant negative correlation between nap timing and nighttime sleep duration and also a significant positive correlation between nap timing and sleep onset time, suggesting that naps in the late afternoon also lead to short nighttime sleep duration and late sleep onset. Our findings suggest that duration-controlled naps starting early in the afternoon can induce a longer nighttime sleep in full-term infants of approximately 1.5 years of age.

Previous studies have demonstrated that a light-dark cycle has promoted better sleep development and weight gain in preterm infants than constant light or constant darkness. However, it was unknown whether brief light exposure at night for medical treatment and nursing care would compromise the benefits brought about by such a light-dark cycle. To examine such possibility, we developed a special red LED light with a wavelength of >675 nm which preterm infants cannot perceive. Preterm infants born at <36 weeks' gestational age were randomly assigned for periodic exposure to either white or red LED light at night in a light-dark cycle after transfer from the Neonatal Intensive Care Unit to the Growing Care Unit, used for supporting infants as they mature. Activity, nighttime crying and body weight were continuously monitored from enrolment until discharge. No significant difference in rest-activity patterns, nighttime crying, or weight gain was observed between control and experimental groups. The data indicate that nursing care conducted at 3 to 4-hour intervals exposing infants to light for <15 minutes does not prevent the infants from developing circadian rest-activity patterns, or proper body growth as long as the infants are exposed to regular light-dark cycles.

Pre-eclampsia affects approximately 5% of all pregnant women and remains a major cause of maternal and fetal morbidity and mortality. The hypertension associated with pre-eclampsia develops during pregnancy and remits after delivery, suggesting that the placenta is the most likely origin of this disease. The pathophysiology involves insufficient trophoblast invasion, resulting in incomplete narrow placental spiral artery remodeling. Placental insufficiency, which limits the maternal-fetal exchange of gas and nutrients, leads to fetal intrauterine growth restriction. In this study, in our attempt to develop a new therapy for pre-eclampsia, we directly rescued placental and fetal hypoxia with nano-scale size artificial oxygen carriers (hemoglobin vesicles). The present study is the first to demonstrate that artificial oxygen carriers successfully treat placental hypoxia, decrease maternal plasma levels of anti-angiogenic proteins and ameliorate fetal growth restriction in the pre-eclampsia rat model.