Intravenous atropine therapy (IAT) is feasible for infantile hypertrophic pyloric stenosis (IHPS). Currently, IAT is recommended for only patients with risks against surgery. However, reported proportions of successful IAT ranged widely, being from 70 to 90%. Factors related to successful IAT remain unknown. This study aimed to identify predictive factors of successful IAT for IHPS using a national inpatient database in Japan.
Using the Diagnosis Procedure Combination database, we identified children with IHPS from July 2010 to March 2016. We compared patients’ characteristics between the IAT and surgery groups, and between the successful and unsuccessful IAT groups. Multivariable logistic regression analysis was performed for successful IAT.
We identified 1,822 eligible patients (526 IAT patients). IAT had a success rate of 73.4% (n = 386) and 140 unsuccessful patients subsequently underwent surgery. Body weight at admission in the successful group was significantly heavier than that in the unsuccessful group. The Multivariate logistic analysis showed that the proportion of successful IATs was significantly higher in the heavy weight (4,000–4,999 g) (odds ratio, 2.03; 95% confidence interval, 1.32–3.13) and very heavy weight (≥5,000 g) groups (odds ratio, 5.35; 95% confidence interval, 1.80–15.9) than in the middle weight (3,000–3,999 g) group.
Heavier body weight was associated with successful IAT. These results are useful for patients select therapeutic options for IHPS, including surgery and IAT.
Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is an autoimmune disease with multiple neurologic symptoms with or without a tumor, including ovarian teratoma. In the present study, a national inpatient database in Japan was used to investigate the characteristics, treatment, and outcomes of hospitalized patients with anti-NMDAR encephalitis who received initial treatment.
Using the Diagnosis Procedure Combination database, we identified all patients who were diagnosed with anti-NMDAR encephalitis and received initial first-line treatments (methylprednisolone, intravenous immunoglobulin, plasma exchange, and tumor removal) and second-line treatments (cyclophosphamide and rituximab) from July 2010 to March 2017. We excluded patients who received no immunotherapy or surgical treatment and those for whom data were missing. We investigated the characteristics, treatment, and outcomes of eligible patients.
In total, 163 eligible patients were identified. Of these patients, 116 (71%) were female and 44 (28%) were ≤19 years of age. Among the female patients, 44 (38%) had a tumor. Thirty-nine patients (24%) were admitted to the intensive care unit during their hospitalization. Methylprednisolone, intravenous immunoglobulin, and plasma exchange were used as initial therapy in 82%, 56%, and 34% of patients, respectively. Second-line treatments were rarely used. Most patients were alert or had a slight disturbance of consciousness upon discharge. The proportion of patients discharged to home was 55%.
The results of this Japanese study on anti-NMDAR encephalitis suggest that patients’ characteristics and outcomes including the male-to-female ratio, proportion of associated tumors, treatment options, and consciousness disturbance may differ from those in previous reports from other countries.
Systematic reviews and other studies have not supported the routine use of inhaled nitric oxide (iNO) for preterm infants with respiratory failure. However, despite the lack of evidence, many physicians use iNO for a subgroup of preterm infants with respiratory failure, such as cases of persistent pulmonary hypertension of the newborn (PPHN). This study aimed to clarify whether the use of iNO improved the mortality rate among preterm infants with PPHN.
We analyzed data from the Neonatal Research Network in Japan, which is a population-based nationwide registry. The study included neonates who were born at <32 weeks of gestational age between 2006 and 2012 and were diagnosed with PPHN without major congenital malformation including serious congenital heart disease. The primary outcome was the in-hospital mortality rate. Confounder-adjusted odds ratios were estimated using mixed effects logistic regression accounting for clustering within hospitals as random effects and covariates as fixed effects.
We identified 1,231 eligible infants, including 739 infants (60%) who received iNO. iNO did not significantly improve mortality (odds ratio [OR]: 1.13, 95% confidence interval [CI]: 0.82–1.55, P = 0.45). iNO was significantly associated with bronchopulmonary dysplasia (OR: 1.50, 95% CI: 1.11–2.02, P = <0.01) and retinopathy of prematurity requiring treatment (OR: 1.56, 95% CI: 1.11–2.19, P = 0.01).
This retrospective study failed to detect an association between iNO treatment and improved survival among preterm infants with PPHN, however, there are several limitations in this study. Further research is required in this area.