Reduced oxygen protocol decreases the incidence of threshold retinopathy of prematurity in infants of <33 weeks gestation.

BACKGROUND: The relationship between oxygen and retinopathy of prematurity (ROP) has been studied frequently, and a pulse oximeter has the potential to facilitate the control of oxygen fluctuation in neonates. The objective of the present study was to compare the incidence of threshold ROP (stage 3 requiring laser treatment and stage 4) in infants of <33 weeks gestation after implementing a new clinical O(2) management practice. METHODS: A retrospective study of data from the Kyoto First Red Cross Hospital neonatal intensive care unit (NICU) from 1 July 2004 to 31 October 2007 (closed 1 December 2006-30 March 2007 for reconstruction). A reduced oxygen protocol was implemented to maintain oxygen saturation (SpO(2)) values using a pulse oximeter between 88% and 92%. The incidence of threshold ROP in the earlier period (1 July 2004-31 December 2005) and the later period (1 January 2006-31 October 2007) were compared. RESULTS: The incidence of threshold ROP significantly decreased from 32.2% to 16.7%, after changing to the reduced oxygen protocol (P < 0.05). CONCLUSION: A significant decrease in the rate of threshold ROP in infants of <33 weeks gestation was observed after implementation of the new clinical O(2) management practice.

Extravascular collection of fluid around the vertebra resulting from malpositioning of a peripherally inserted central venous catheter in extremely low birth weight infants.

Peripherally inserted central venous catheters (PICCs) have allowed central venous access via peripheral veins for a long period. PICCs have become an indispensable tool in neonatal medicine. Despite their benefits, PICCs involve some risks, which include infection, thrombosis, malpositioning, and extravascular collection of fluid. We presented two patients with extravascular collection of fluid around the vertebra resulting from malpositioning of PICCs. The PICCs were placed via the saphenous veins in both patients. The PICCs were judged to be centrally placed in the inferior vena cava by means of supine abdominal roentgenograms. The next day one patient exhibited frequent apneic attacks and the other exhibited twitching movements. A lumbar puncture revealed extravascular collection of fluid around the vertebra. In lateral view chest-abdominal roentgenograms, the PICC tips were observed to be in the vertebral lumen. The PICCs were removed immediately and the condition of the patients improved. We stressed the usefulness of the lateral view abdominal roentgenograms for revealing the malpositioning of PICCs in the inferior vena cava.

Asymptomatic self-limiting white matter lesions in the chronic phase of herpes simplex encephalitis.

We report a 9-month-old girl with herpes simplex encephalitis. T(2)-weighted magnetic resonance imaging (MRI) on the 8th day of illness showed increased signal intensity in the gray and white matter of the bilateral lobes, especially the right temporo-parietal lobe. High voltage slow waves were recorded in the right parieto-occipital region on electroencephalography. She was discharged on the 34th day of illness without sequelae. On discharge, the high signal intensity on MRI had improved and the abnormal slow waves on electroencephalography had disappeared. At 4 months after the onset of illness, MRI revealed decreased signal intensities in T(1)-weighted images and increased signal intensities in T(2)-weighted images in the periventricular white matter adjacent to the posterior horns of the lateral ventricles. The white matter lesions had expanded at 9 months after the onset of illness. At 14 months after the onset of illness, the white matter lesions were reduced in size, and at 2 years after the onset of illness, they had completely disappeared. During 2 years follow-up after discharge, however, there were no neurological abnormalities corresponding to the lesions and her psychomotor development was normal. Although the mechanism underlying these white matter lesions had not been elucidated, an immune-mediated complication such as edema or demyelination is suspected. Repeat MRI studies over a long period are necessary to follow up a patient with herpes simplex encephalitis.