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Miyazono Y, Arai J, Kanai Y, Hitaka D, Kajikawa D, Takeuchi S, Nagafuji M, Fujiyama S, Saito M, Takada H. Nationwide survey of late-onset hemolysis in very low birthweight infants. Pediatr Int 2021; 63:172-176. [PMID: 33012035 PMCID: PMC7986906 DOI: 10.1111/ped.14493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/16/2020] [Accepted: 09/28/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND In Japan, some cases of late-onset acute hemolysis in very low birthweight (VLBW) infants have been reported. These cases had common features but the cause of hemolysis was unknown. The incidence and prognosis of this disease are also unknown. However, there are only few reports of such hemolytic episodes in countries other than Japan. Thus, this study aimed to examine the incidence and clinical course of late-onset acute hemolysis and to establish it as a new disease concept. METHODS A nationwide prospective survey was conducted from 2011 to 2015 as a rare disease surveillance project of the Japan Society for Neonatal Health and Development. RESULTS Twenty-four cases were confirmed. The median (range) gestational age, birthweight, and onset of hemolytic episodes were 26 weeks and 2 days (23 weeks and 4 days-31 weeks and 2 days), 898 g (627-1,416 g), and 19 days after birth (9-33 days), respectively. Phototherapy, blood transfusion, and exchange transfusion were required in 22 (96%), 24 (100%), and 7 (29%) cases, respectively. During the observation period, no recurrence of the hemolytic episode occurred. All patients survived; however, one case developed kernicterus and suffered severe neurological sequelae. CONCLUSIONS In this study, at least 1 out of 1,259 VLBW infants developed hemolysis at 9-33 days after birth in Japan. Owing to the risk of kernicterus, this disease should be recognized as among the important pathological conditions of VLBW infants, suggesting the need to manage jaundice and anemia until 5 weeks after birth.
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Affiliation(s)
- Yayoi Miyazono
- Departments of, Department of, Child Health, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.,Department of, Pediatrics, University of Tsukuba Hospital, Tsukuba, Japan
| | - Junichi Arai
- Department of, Neonatology, Ibaraki Children's Hospital, Mito, Japan
| | - Yu Kanai
- Departments of, Department of, Child Health, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.,Department of, Pediatrics, University of Tsukuba Hospital, Tsukuba, Japan
| | - Daisuke Hitaka
- Department of, Pediatrics, University of Tsukuba Hospital, Tsukuba, Japan
| | - Daigo Kajikawa
- Department of, Pediatrics, University of Tsukuba Hospital, Tsukuba, Japan
| | - Shusuke Takeuchi
- Department of, Pediatrics, University of Tsukuba Hospital, Tsukuba, Japan
| | - Motomichi Nagafuji
- Department of, Pediatrics, University of Tsukuba Hospital, Tsukuba, Japan
| | - Satoshi Fujiyama
- Department of, Pediatrics, University of Tsukuba Hospital, Tsukuba, Japan
| | - Makoto Saito
- Departments of, Department of, Child Health, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.,Department of, Pediatrics, University of Tsukuba Hospital, Tsukuba, Japan
| | - Hidetoshi Takada
- Departments of, Department of, Child Health, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.,Department of, Pediatrics, University of Tsukuba Hospital, Tsukuba, Japan
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Watchko JF. The Enigma of Preterm Late Hyperbilirubinemia Kernicterus in Japan. Neonatology 2021; 118:340-341. [PMID: 33774641 DOI: 10.1159/000514758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 01/07/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Jon F Watchko
- Department of Pediatrics, University of Pittsburgh School of Medicine, Magee-Womens Hospital, Pittsburgh, Pennsylvania, USA
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Ghotra S, Jangaard K, Pambrun C, Fernandez CV. Congenital methemoglobinaemia due to Hb F-M-Fort Ripley in a preterm newborn. BMJ Case Rep 2016; 2016:bcr-2016-214381. [PMID: 26969357 DOI: 10.1136/bcr-2016-214381] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Methemoglobinaemia is a rare cause of cyanosis in newborns. Congenital methemoglobinaemias due to M haemoglobin or deficiency of cytochrome b5 reductase are even rarer. We present a case of congenital methemoglobinaemia presenting at birth in a preterm infant. A baby boy born at 29 weeks and 3 days of gestation had persistent central cyanosis immediately after delivery, not attributable to a respiratory or cardiac pathology. Laboratory methemoglobin levels were not diagnostic. Cytochrome b5 reductase levels were normal and a newborn screen was unable to pick up any abnormal variants of fetal haemoglobin. Genetic testing showed a γ globin gene mutation resulting in the M haemoglobin, called Hb F-M-Fort Ripley. The baby had no apparent cyanosis at a corrected gestational age of 42 weeks. Although rare, congenital methaemoglobin aemia should be considered in the differential in a preterm with central cyanosis and investigated with genetic testing for γ globin chain mutations if other laboratory tests are non-conclusive.
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Nagasaka M, Kikuma T, Iwatani S, Kurokawa D, Yamana K, Maeyama K, Koda T, Matsumoto H, Taniguchi-Ikeda M, Iijima K, Nakamura H, Morioka I. Transcutaneous bilirubin monitoring predicts unexplained late-onset hemolysis in a very low birthweight infant. BMC Res Notes 2016; 9:153. [PMID: 26965169 PMCID: PMC4785658 DOI: 10.1186/s13104-016-1970-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 02/29/2016] [Indexed: 11/17/2022] Open
Abstract
Background In term infants, transcutaneous bilirubin (TcB) monitoring can be used to predict hemolytic hyperbilirubinemia. However, it is not clear whether the technique can also be used to predict unexplained late-onset hemolysis in very low birthweight (VLBW) infants. Case presentation The case was an infant with a birthweight of 1154 g who developed unexplained late-onset hemolysis at 8 days of age. The hyperbilirubinemia rapidly worsened, and therefore both phototherapy and exchange transfusion were performed. TcB levels were measured using the JM-105 jaundice meter and found to have increased by >3 mg/dL since before the onset, demonstrating for the first time that the device clearly detects changes in hemolytic rate. Conclusions Although TcB levels did not correspond directly with total serum bilirubin levels in VLBW infants, the two values exhibited parallel changes in this case. Therefore, serial TcB monitoring may be useful in the early prediction of unexplained late-onset hemolysis in VLBW infants.
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Affiliation(s)
- Miwako Nagasaka
- Department of Pediatrics, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Tomoe Kikuma
- Clinical Laboratory, Kobe University Hospital, Kobe, Japan
| | - Sota Iwatani
- Department of Pediatrics, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Daisuke Kurokawa
- Department of Pediatrics, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Keiji Yamana
- Department of Pediatrics, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Kaori Maeyama
- Department of Pediatrics, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Tsubasa Koda
- Department of Pediatrics, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | | | - Mariko Taniguchi-Ikeda
- Department of Pediatrics, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Kazumoto Iijima
- Department of Pediatrics, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Hajime Nakamura
- Department of Pediatrics, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Ichiro Morioka
- Department of Pediatrics, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
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