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The long-term follow-up of lung function (LF) in extremely preterm (EP) infants with bronchopulmonary dysplasia (BPD) has shown a worldwide increase in small airway obstructions (SAO).We investigated the relationships between intrauterine Ureplasma infection in EP infants and bubbly/cystic lung, BPD, and SAO at school age.Placental pathology, placental Ureaplasma DNA (pU-DNA), and cord blood immunoglobulin M (IgM) (C-IgM) were investigated in 360 EP infants born from 1981 to 2004. Maternal amniotic inflammatory response (M-AIR) scores and hemosiderin deposition (HD) were estimated in the chorioamnion. The study subjects were divided into groups based on their M-AIR scores. Their LF at school age was compared with those of 33 healthy siblings.pU-DNA and C-IgM were significantly related to SAO at school age (p 0.012). M-AIR score 3 and pU-DNA1000 units had an odds ratio (OR) of 35 (95% confidence interval: 10-172) and 18 (5.6-67) for bubbly/cystic lung, and 11 (3.1 - 43) and 31 (4.5-349) for severe BPD, and 5.3 (2.1-11) and 12 (2.4-74) for SAO, respectively. The ORs of surfactant treatment, BPD grade III, OOur long-term cohort study of LF in EP infants revealed that intrauterine Ureaplasma was associated with bubbly/cystic lung, severe BPD, and SAO at school age.

BackgroundOutcomes of prenatal covariate-adjusted outborn very-low-birth-weight infants (VLBWIs) (≤1500 g) remain uncertain.ObjectiveTo compare morbidity and mortality between outborn and inborn VLBWIs.DesignObservational cohort study using inverse-probability-of-treatment weighting.SettingNeonatal Research Network of Japan.PatientsSingleton VLBWIs with no major anomalies admitted to a neonatal intensive care unit from 2012 to 2016.MethodsInverse-probability-of-treatment weighting with propensity scores was used to reduce imbalances in prenatal covariates (gestational age (GA), birth weight, small for GA, sex, maternal age, premature rupture of membranes, chorioamnionitis, preeclampsia, maternal diabetes mellitus, antenatal steroids and caesarean section). The primary outcome was severe intraventricular haemorrhage (IVH). The secondary outcomes were outcomes at resuscitation, other neonatal morbidities and mortality.ResultsThe full cohort comprised 15 842 VLBWIs (668 outborns). The median (IQR) GA and birth weight were 28.9 (26.4–31.0) weeks and 1128 (862–1351) g for outborns and 28.7 (26.3–30.9) weeks and 1042 (758–1295) g for inborns. Outborn VLBWIs had a higher incidence of severe IVH (8.2% vs 4.1%; OR, 3.45; 95% CI 1.16 to 10.3) and pulmonary haemorrhage (3.7% vs 2.8%; OR, 5.21; 95% CI 1.41 to 19.2). There were no significant differences in Apgar scores, oxygen rates at delivery, intubation ratio at delivery, persistent pulmonary hypertension of the newborn, IVH of any grade, periventricular leukomalacia, chronic lung disease, oxygen at discharge, patent ductus arteriosus, retinopathy of prematurity, necrotising enterocolitis, sepsis or mortality.ConclusionOutborn delivery of VLBWIs was associated with an increased risk of severe IVH.

This study aimed to assess the effect of dopamine on the development of infections after birth in extremely preterm infants. We retrospectively identified 258 extremely preterm infants (born at < 28 gestational weeks) between July 2009 and December 2018 in a tertiary neonatal intensive care unit (NICU). We extracted data on potential risk factors for infection, total amount of dopamine, and infection history during NICU stay for each infant. We compared the infection group with the non-infection group, and used the Cox proportional hazard regression analysis to identify risk factors for infection during NICU stay. After adjustment for all potential risk factors, factors that significantly affected development of infection were gestational age (hazard ratio [HR], 0.70; 95% confidence interval [CI] 0.55-0.89; p = 0.004) and total amount of dopamine (HR, 1.04; 95% CI 1.02-1.07; p = 0.002). The receiver operating characteristic curve of total amount of dopamine for infection suggested that total amount of dopamine greater than 7.271 mg/kg predicted infection development with 80.4% sensitivity and 41.7% specificity.Conclusion: A large amount of dopamine can increase infections in extremely preterm infants. We should avoid using a large amount of dopamine and remain aware of the potential development of infections in extremely preterm infants. What is Known: • Inotropes are often used for extremely preterm infants and dopamine is the most commonly used inotrope. • However, it is suggested that dopamine affects the immune system and related infections. What is New: • This is the first study of the association between the amount of dopamine and infection in extremely preterm infants. • We should avoid using a large amount of dopamine in extremely preterm infants.

Treatment for extremely preterm infants born at less than 25 weeks of gestation in Japan was initiated mainly due to the amendment of the Maternal Health Act lowering the upper limit of abortion from 24 weeks to 22 weeks in 1990. Five years after the amendment, the Japanese national government started a nationwide project to improve the perinatal care system. Once selected perinatal centers reported improvements in survival rates, more centers have adopted aggressive treatments. They have accumulated their knowledge by experiencing the treatment of infants with a limit of viability. As a result, more than 50% of infants born even at 22 weeks of gestation can survive to discharge currently. This progress has resulted from the accumulation of experience at each perinatal center rather than the results from clinical trials. Furthermore, these experiences have been standardized to some extent through sharing information.

To determine the trends in inhaled nitric oxide (iNO) utilization in the late phase of hospitalization in a large Japanese cohort of extremely preterm infants and evaluate its benefit on long-term outcomes.This was a retrospective multicenter cohort study of 15 977 extremely preterm infants born at28 weeks of gestational age between 2003 and 2016, in the Neonatal Research Network, Japan. Demographic characteristics, morbidity, and mortality were compared between extremely preterm infants with and without post-acute iNO therapy. Multivariable logistic analysis was performed to determine factors associated with post-acute iNO and its impact on neurodevelopmental outcomes at 3 years of age.Post-acute iNO utilization rates increased from 0.3% in 2009 to 1.9% in 2016, even under strict insurance coverage rules starting in 2009. Gestational age (1-week increment; aOR 0.82, 95% CI 0.76-0.88), small for gestational age (1.47, 1.08-1.99), histologic chorioamnionitis (1.50, 1.21-1.86), 5-minute Apgar score4 (1.51, 1.10-2.07), air leak (1.92, 1.30-2.83), and bubbly/cystic appearance on chest X-Ray (1.68, 1.37-2.06) were associated with post-acute iNO. Post-acute iNO was not associated with neurodevelopmental outcomes at 3 years of age.The increasing post-acute iNO utilization rate among extremely preterm infants has been concurrent with improved survival rates of extremely preterm infants in Japan. Infants treated with post-acute iNO had more severe disease and complications than the comparison group, but there were no differences in neurodevelopmental outcome at 3 years. This suggests post-acute iNO may benefit extremely preterm infants.

The study aimed to evaluate the association between bronchopulmonary dysplasia (BPD) development at 36 weeks' postmenstrual age (PMA) and Gram-negative bacteria in tracheal aspirate cultures among extremely preterm infants. This study has a retrospective cohort. Patients were 155 infants aged less than or equal to 26 gestational weeks who were admitted to the neonatal intensive care unit of Osaka Women's and Children's Hospital from 2009 to 2018. Primary outcome was respiratory outcomes expressed as BPD development.Multivariable logistic regression analysis was used to identify neonatal and bacterial factors associated with BPD. After adjusting for gestational age, birth weight, sex, chorioamnionitis, Gram-positive cocci (GPC) and Gram-negative rods (GNRs) in tracheal aspirate cultures within 28 days after birth, GNRs were significantly associated with BPD development (odds ratio [OR]: 3.88, 95% confidence interval [CI]: 1.68-8.94). In contrast, GPCs were not associated with BPD development (OR: 0.47, 95% CI: 0.05-1.61). Gram-negative bacteria in tracheal cultures within 28 days of birth are associated with BPD development in infants aged less than or equal to 26 gestational weeks.· BPD is a factor for morbidity in extremely preterm infants.. · Respiratory infection is an adverse outcome of BPD.. · GNRs in tracheal cultures soon after birth disturb BPD development.. · GPC was not associated with BPD development..

To investigate factors associated with development of severe retinopathy of prematurity (ROP) in extremely preterm (EP) infants. This retrospective cohort study included 213 EP infants (22 + 0 to 27 + 6 weeks gestation) who were admitted to the neonatal intensive care unit of Osaka Women’s and Children’s Hospital between 2009 and 2017. Multivariable logistic regression analysis was used to identify neonatal factors associated with severe ROP requiring treatment. After adjustments for gestational age (GA), birth weight, sex, red blood cell transfusion, average SpO2, and fluctuations of SpO2 from birth to 32 weeks postmenstrual age, fluctuations of SpO2 (odds ratio [OR]: 2.10, 95% confidence interval [CI]: 1.03–4.27), and low GA (OR: 0.95, 95% CI: 0.91–0.98) were significantly associated with severe ROP. Fluctuations of SpO2 from birth to 32 weeks postmenstrual age and low GA were significantly associated with development of severe ROP requiring treatment in EP infants.

With the advent of the aging society, the demand for nursing care for the elderly is becoming much larger. The application of robotics to helping on-site caregivers is consequently one of the most important new areas of robotics research. Such humaninteractive robots, which share humans’ environments and interact with them, should be covered with soft areal tactile sensors for safety, communication, and dextrous manipulation. Tactile sensors have interested many researchers and various types of tactile sensors have been proposed so far. Many tactile sensors have been developed on the basis of microelectro-mechanical system (MEMS) technology (for example, (Suzuki, 1993; Souza & Wise, 1997)). They have a high-density and narrow covering area realized by applying MEMS technology, and as a result, are not suitable for covering a large area of a robot’s surface. Some tactile sensors suitable for use on robot fingers or grippers have also been developed (Nakamura & Shinoda, 2001; Yamada et al., 2002; Shimojo et al., 2004). Many of them have the ability to detect tangential stress and can be used in grasping force control. Their main target is robot fingers, and consequently they were not designed to cover a large area. There are also commercially available tactile sensors such as those offered by Tekscan (Tekscan, 2008) based on pressure-sensitive ink or rubber, and KINOTEXTM tactile sensors (Reimer & Danisch, 1999) utilizing the change in the intensity of light scattered by the covering urethane foam when deformed. However, they are not sufficiently accurate because of strong hysteresis and creep characteristics. The idea of covering a large area of a robot’s surface with soft tactile skinlike sensors is attracting researchers (Lumelsky et al., 2001). Some human-interactive robots for which a large area of their surface is covered with soft tactile sensors have actually been developed (Inaba et al. 1996; Tajima et al. 2002; Kanda et al. 2002; Mitsunaga et al. 2006; Ohmura et al., 2006; Ohmura & Kuniyoshi, 2007). However, the tactile sensors are not suitable for humaninteractive robots, particularly when physical labor using tactile sensation is required. For example, one tactile sensor in (Tajima et al. 2002) has only 3 values as its output, and another tactile sensor in (Tajima et al. 2002) is gel-type and cannot be used over a long period because of the evaporation of the contained water. The tactile sensor in (Mitsunaga et al. 2006) has only 56 elements in total. Flexible fabric-based tactile sensors using an electrically conductive fabric have also been proposed for covering a robot (Inaba et al. 1996), but the O pe n A cc es s D at ab as e w w w .in te ch w eb .o rg

We examined the effects of maternal hypertensive disorders of pregnancy (HDP) on the mortality and neurodevelopmental outcomes in preterm very low birth weight (VLBW) infants (BW ≤1,500 g) based on their intrauterine growth status and gestational age (GA).We included singleton VLBW infants born at32 weeks' gestation registered in the Neonatal Research Network Japan database. The composite outcomes including death, cerebral palsy (CP), and developmental delay (DD) at 3 years of age were retrospectively compared among three groups: appropriate for GA (AGA) infants of mothers with and without HDP (H-AGA and N-AGA) and small for GA (SGA) infants of mothers with HDP (H-SGA). The adjusted odds ratios (AOR) and 95% confidence intervals (CI) stratified by the groups of every two gestational weeks were calculated after adjusting for the center, year of birth, sex, maternal age, maternal diabetes, antenatal steroid use, clinical chorioamnionitis, premature rupture of membranes, non-life-threatening congenital anomalies, and GA.Of 19,323 eligible infants, outcomes were evaluated in 10,192 infants: 683 were H-AGA, 1,719 were H-SGA, and 7,790 were N-AGA. Between H-AGA and N-AGA, no significant difference was observed in the risk for death, CP, or DD in any GA groups. H-AGA had a lower risk for death, CP, or DD than H-SGA in the 24 to 25 weeks group (AOR: 0.434, 95% CI: 0.202-0.930). The odds for death, CP, or DD of H-SGA against N-AGA were found to be higher in the 24 to 25 weeks (AOR: 2.558, 95% CI: 1.558-3.272) and 26 to 27 weeks (AOR: 1.898, 95% CI: 1.427-2.526) groups, but lower in the 30 to 31 weeks group (AOR: 0.518, 95% CI: 0.335-0.800).There was a lack of follow-up data; however, the outcomes of liveborn preterm VLBW infants of mothers with HDP depended on their intrauterine growth status and GA at birth.· The effects of HDP on preterm low birth weight infants need to be further examined.. · The outcomes were not different between AGA infants with and without maternal HDP.. · The outcomes of SGA infants with maternal HDP were dependent on their GA..

BACKGROUND A capnometer is a noninvasive monitor that is used to assess patients' respiratory status. This study was performed to evaluate the availability of a portable capnometer in children with tracheostomy. METHODS This retrospective study included children with tracheostomy who were treated at the Osaka Women's and Children's Hospital Osaka, Japan, from 1 September 2018 to 31 October 2019. We assessed the correlation between the partial pressure of venous carbon dioxide (PvCO2 ) and end-tidal carbon dioxide tension (EtCO2 ) using a portable capnometer (EMMA; Masimo, Irvine, CA, USA). RESULTS Nine infants and 43 simultaneous PvCO2 -EtCO2 pairs were analyzed. The correlation coefficient of these pairs was 0.87 (95% confidence interval, 0.77-0.93; P < 0.001). The Bland-Altman plot showed that EtCO2 was on average 10.0 mmHg lower than its paired PvCO2 value (95% limits of agreement, 1.0-19.1). The difference between PvCO2 and EtCO2 was significantly greater in patients on ventilators. CONCLUSIONS The portable capnometer evaluated in this study (EMMA) was readily available and useful for assessment of the respiratory condition in children with tracheostomy.

Background The assessment of long-term outcomes in survivors born with extremely low birth weights (ELBWs) has become increasingly important. However, little has been reported on the physical fitness of non-disabled school-aged children born with ELBWs. Aims To assess the physical fitness of non-disabled school-aged children born with ELBWs. Study design Retrospective cohort study. Subjects We analyzed 169 ELBW infants without cerebral palsy or intellectual disability (based on the Wechsler Intelligence Scale for Children—Third Edition (WISC-III) Full Scale intelligence quotient (IQ) test Outcome measures Physical fitness was assessed using the grip strength, sit-up repetitions, sit & reach, side steps, standing long jump, and softball throw tests. T-scores were calculated using national survey data. Results The T-scores for the grip strength, sit-up repetitions, sit & reach, side steps, standing long jump, softball throw tests, and the overall T-score were 43.7 ± 7.5, 44.2 ± 10.5, 46.0 ± 9.7, 40.9 ± 8.0, 40.0 ± 9.8, 42.4 ± 8.1, and 42.9 ± 5.5, respectively. After adjusting for other age-related factors, the height (SD score), WISC-III Performance IQ score, and percent predicted forced vital capacity (FVC) independently predicted the overall T-scores. Their standardized partial regression coefficients (β) were 0.334 (p = 0.009), 0.190 (p = 0.022), and 0.187 (p = 0.032), respectively. Conclusions Our cohort's physical fitness at approximately 8 years of age was significantly impaired compared to average Japanese children of the same age. Height, FVC, and Performance IQ independently predicted physical fitness, with height being the strongest predictor.

OBJECTIVES This study aimed to describe postnatal physiological changes in maximum values of peak electrical activity of the diaphragm (Edi) in extremely preterm infants during the preterm period. WORKING HYPOTHESIS The amplitude and frequency of neural sigh are different at each postmenstrual age in extremely preterm infants. STUDY DESIGN A retrospective, observational study. PATIENT-SUBJECT SELECTION Edi values were evaluated in 14 extremely preterm infants with neurally-adjusted ventilatory assist. METHODOLOGY Data of Edi peak and Edi minimum were collected from a ventilator. Edi-sigh was defined as the Edi peak value that was more than twice as large as the median Edi peak at each postmenstrual week in each patient. The frequency of Edi-sigh, and median values of Edi-sigh, Edi peak, and Edi minimum were evaluated at each postmenstrual week. The Jonckheere-Terpstra test was used to analyze the trend between postmenstrual weeks and Edi values. RESULTS From 26 to 35 postmenstrual weeks, the number of Edi-sighs per hour significantly increased as postmenstrual weeks increased (P

In order to assess the development, approval and early introduction into clinical practice of biologics in the pediatric field, we herein describe the current status of the development to approval of biologics as anti-rheumatic agents for children in Japan, discuss the present problems and provide a proposal for the future. It has become apparent that the duration of the review period required for the preparation of clinical trials and Pharmaceuticals and Medical Devices Agency approval is clearly reduced compared with the past. Thus, it was speculated that a rate-limiting step in the process from development to approval was the duration of clinical trials from start to end. Hence, we focused on the following key words with regard to promotion of the development of biologics and their early practical use: "registry", "centralization", and "global cooperation", all of which are related to the reduction of duration of a clinical trial. In conclusion, to reduce the duration of a clinical trial, it is essential to complete a world-scale registry system by developing the registry system established by the Pediatric Rheumatology Association of Japan. The next step is then to carefully plan to participate in the international network using the world-scale registry system, and develop global cooperative trials in which we can ensure a sufficient number of entries from Japan.

Purpose To evaluate differences in the progression pattern among subtypes of retinopathy of prematurity (ROP). Design Retrospective cohort study. Participants Premature infants screened for ROP. Methods Medical records of 578 premature infants who were screened at the neonatal intensive care unit from September 2009 through March 2016 were reviewed. We matched for the number of patients, gestational age at birth, and postmenstrual age at the first examination between infants with spontaneously regressed ROP and those with treated ROP. A total of 133 premature infants who were born before 27 weeks’ gestation were included. Main Outcome Measures The mean age at onset of any ROP and the duration from the initial examination to onset were compared between infants with regressed ROP and those with treated ROP. The mean age at treatment and the duration from onset to treatment were compared between infants with type 1 ROP and those with aggressive posterior ROP (AP-ROP). Data were analyzed for 1 randomly selected eye for each infant. Results Of 133 premature infants with any ROP, 67 regressed spontaneously, 43 demonstrated type 1 ROP, and 23 demonstrated AP-ROP. Individual trajectories of ROP progression over time showed that AP-ROP progressed through the stages in a steep linear manner in most cases. In contrast, the type 1 ROP and regressed ROP developed in a slower, stepwise manner. Conclusions In infants with ROP, the disease trajectories across ROP stages are different based on the ROP subtype, despite postmenstrual age at onset being comparable across subtypes. Our findings could be useful for managing follow-up screening.

OBJECTIVES To assess lung function and long-term respiratory outcomes in extremely low birth weight (ELBW) survivors. WORKING HYPOTHESIS ELBW, especially with respiratory complications in the neonatal period, affects lung function at a later age. STUDY DESIGN Longitudinal retrospective study. PATIENT-SUBJECT SELECTION Lung function was evaluated in 89 ELBW survivors (at ages 8 and 12) with or without a history of bronchopulmonary dysplasia (BPD) or a bubbly/cystic lung appearance in the neonatal period. METHODOLOGY FVC, FEV1, FEF50, and FEF75 were measured using spirometry. Two-way repeated-measures ANOVA was used to compare lung function and deterioration time course from 8 to 12 years of age. RESULTS Lung function variables were significantly and positively correlated between 8 and 12 years: %FVC (R2 = 0.558), %FEV1 (R2 = 0.539), %FEF50 (R2 = 0.412), and %FEF75 (R2 = 0.429). Lung function values were lower than Japanese reference values, especially in children with a history of severe BPD or a bubbly/cystic appearance. %FEV1 and FEV1/FVC ratio worsened from 8 to 12 years of age: 83.0 ± 17.0% versus 76.6 ± 17.8% (mean difference, 95%CI: −6.43, −9.10 to −3.75) and 84.0 ± 10.1% versus 78.2 ± 13.4% (mean difference, 95%CI: −5.82, −8.56 to −3.08), regardless of whether or not there was a history of neonatal respiratory disease. CONCLUSIONS In ELBW survivors, the obstructive pattern of lung function impairment deteriorated from 8 to 12 years of age, independent of the presence of severe BPD or bubbly/cystic appearance in the neonatal period.

Objective We hypothesised that a prophylactic inhaled steroid would prevent the progression of bronchopulmonary dysplasia (BPD) in extremely low birthweight infants (ELBWIs). Design This study was a multicentre, randomised, double-blinded, placebo-controlled trial. Setting This investigation was conducted in 12 level III neonatal intensive care units (NICUs). Patients A total of 211 ELBWIs requiring ventilator support were enrolled. Intervention Starting within 24 h of birth and continuing until 6 weeks of age or extubation, two doses of 50 μg fluticasone propionate (FP) or placebo were administered every 24 h. Main outcome measurement The primary outcome measure used to indicate the morbidity of severe BPD incidence was death or oxygen dependence at discharge from the NICU. The secondary measures were neurodevelopmental impairments (NDIs) at 18 months of postmenstrual age and 3 years of age. We performed subgroup analyses based on gestational week (GW) and the presence of chorioamnionitis (CAM). Results Infants were randomised into the FP (n=107) or placebo (n=104) groups. No significant differences were detected between the FP and placebo groups with respect to either the frequency of death or the oxygen dependence at discharge or NDIs. In subgroup analyses, the frequencies of death and oxygen dependence at discharge were significantly decreased in the FP group for infants born at 24–26 GWs and for infants with CAM, regardless of the GW at birth. Conclusions Inhaled steroids have no effect on the prevention of severe BPD or long-term NDI but might decrease the severity of BPD for ELBWIs with a risk factor. Trial registration number UMIN-CTR C000000405.

To assess the developmental characteristics of very low-birth-weight (VLBW) infants using the Kyoto Scale of Psychological Development (KSPD) and to compare with those using the Bayley Scales, third edition (Bayley III).KSPD and Bayley III were performed on 124 Japanese VLBW infants at 18months of corrected age at a 2-week interval by trained psychologists. The relationships between KSPD and Bayley III in corresponding pairs: Cognitive-Adaptive (C-A) developmental quotient (DQ) and cognitive composite (Cog) scores, Language-Social (L-S) DQ and language composite (Lang) scores, and Postural-Motor (P-M) DQ and motor composite (Mot) scores were analyzed.The means [SD] of C-A DQ, L-S DQ, P-M DQ, and overall DQ of KSPD were 94 [15], 90 [17], 89 [15], and 93 [14], respectively. The means [SD] of the Cog, Lang, and Mot scores of Bayley III were 96 [13], 84 [12], and 91 [12], respectively. The DQ of KSPD strongly correlated with the corresponding composite score of Bayley III; Spearman rank correlations between the Cog score and C-A DQ, the Lang score and L-S DQ, and the Mot score and P-M DQ were 0.65, 0.71 and 0.55, respectively. The selected cut-off of the Cog score of85 accurately identified development delay, defined by KSPD, with sensitivity of 100% and specificity of 85%.Although absolute value of the Bayley III score may not represent the degree of impairment, the developmental characteristics on KSPD well correlated with those on Bayley III. The developmental outcomes of Japanese VLBW infants were verified by the two tests.

Objective To assess effects of neonatal transport on transient tachypnea of the newborn (TTN) in outborn term neonates. Study Design This retrospective cohort study included 66 term neonates diagnosed with TTN and transported to the Osaka Women's and Children's Hospital neonatal intensive care unit between January 2003 and March 2018. A multivariate logistic regression analysis identified perinatal and neonatal transport factors associated with adverse short-term outcomes defined as mechanical ventilation >48 hours, continuous positive airway pressure >72 hours, pulmonary hemorrhage, and requirement for inhaled nitric oxide, thoracentesis, or surfactant replacement therapy. Results A lower gestational age (GA) (37.7 [37.2, 38.3] vs. 39.6 [37.8, 40.3] weeks, p = 0.002), longer time to neonatal transport (10.0 [4.3, 25.5] vs. 5.5 [2.7, 9.7] hours, p = 0.01), and higher respiratory rates during transport (70 [60, 85] vs. 60 [55, 78.8] breaths/min, p = 0.04) were significantly associated with adverse short-term outcomes. After adjusting for GA, sex, cesarean section, and time to neonatal transport, GA (odds ratio [OR], 0.37; 95% confidence interval [CI], 0.24–0.87) and time to neonatal transport (OR, 1.07; 95% CI, 1.01–1.13) were significantly associated with adverse outcomes. Conclusion Short-term adverse prognosis of TTN is strongly associated with a lower GA and longer time between birth and neonatal transport.

Objectives To determine the accuracy of tidal volume reported by neonatal ventilators, with and without leak compensation, in invasive and noninvasive ventilation modes in the presence of airway leak; and, to determine what factors have a significant effect on the accuracy of tidal volume reported by ventilators with leak compensation in the presence of airway leak. We hypothesized that ventilators with a leak compensation function that includes estimation of tidal volume could accurately report tidal volume in the presence of airway leak, but that the accuracy of reported tidal volume may be affected by variables such as the identity of the ventilator, lung mechanics, leak size, positive end-expiratory pressure level, and body size. Design In vitro assessment of ventilator volume delivery was conducted for seven acute care ventilators using a passive lung simulator. Setting Laboratory-based measurements. Interventions The error of reported tidal volume was calculated under three ventilation modes (noninvasive-pressure-control, invasive-pressure-control, and invasive-dual-control ventilation), three models of lung mechanics (normal and restrictive and obstructive lung disease), a range of airway leak values, two positive end-expiratory pressure values, and two body weights for each ventilator. Ventilators with and without leak compensation were studied. Measurements and main results In the absence of airway leak, all ventilators reported tidal volume accurately. In the presence of airway leak, the error of reported tidal volume increased for all ventilators without a leak compensation algorithm while ventilators with leak compensation that included estimation of tidal volume accurately reported tidal volume. In the presence of airway leak, clinically significant effects on the error of reported tidal volume by ventilators with leak compensation were associated with the choice of ventilator in all modes and with lung mechanics in invasive ventilation modes. Conclusions Reported tidal volume is affected by the presence of airway leak, but in many ventilators a leak compensation algorithm that includes estimation of tidal volume can correct for the discrepancy between actual and reported tidal volume. However, even in ventilators with leak compensation, choice of ventilator and lung mechanics in invasive ventilation modes have a significant effect on error of reported tidal volume.

Aim Methods to improve the mental development of extremely low birthweight (ELBW) children are currently lacking. We assessed the effects of long-term supplementation of alpha-tocopherol on the neurological development of 259 school-aged ELBW children. Methods Extremely low birthweight participants were divided into three groups: group A with no alpha-tocopherol supplementation (n = 121); group B with the supplementation for

We need to solve a multi-period optimization problem to decide dynamic investment policies under various practical constraints. Hibiki (2001,2003,2006) develop the hybrid model where the conditional decision can be made in the simulation approach, and the investment proportions are expressed by the step function of the amount of wealth. In this paper, we introduce the idea of the state-dependent function into the hybrid model as well as Takaya and Hibiki (2012). Atrst, we dene the state-dependent function form for the multiple asset allocation problem with CVaR (Conditional Value at Risk) using the hybrid model, and we clarify that the function form is V-shaped and kinked at the level of the VaR. We propose the piecewise linear model with the V-shaped function to solve the multi-period and state-dependent asset allocation problem. We solve the three period problem forve assets, and compare the piecewise linear model with the hybrid model. We conduct the sensitivity analysis for the different risk averse coefficients and autocorrelations to examine the characteristics of the model.

Introduction Since silicon carbide (SiC) is a very hard substrate and is stable both chemically and physically, wafer processing is costly and takes a lot of time. Particularly, in the chemical mechanical polishing (CMP) process, which is the final wafering process, significant improvement in performance such as surface quality and productivity is required for high volume commercial production. At Fujimi, we have developed a high removal rate slurry of over 1.5 μm per hour on the Si-face under neutral pH and conventional CMP processing conditions. We have also proven that the slurry had a nice behavior in removal rate performance based on Prenston equation, that is, removal rate was proportional to the pressure and velocity of substrate. Furthermore, our testing result has shown great surface morphology such as no scratches and no latent scratches beneath the surface. Low surface roughness was achieved under 0.1nm of RMS at 10x10μm area. Fujimi has introduced this new SiC slurry at the Advanced Industrial Science and Technology (AIST) as a suitable stock polishing slurry to remove surface damage coming from previous grinding or lapping steps. We have demonstrated the benefit of a two-step CMP process which applies a stock step using the higher removal rate slurry followed by a fine step using our Colloidal silica type slurry. As a result, the combination process could realize to produce the SiC epi-ready wafer with fine quality surface in shorter process time than conventional process [1]. Results and Discussion In this study, we will discuss our SiC slurry development technologies. At Fujimi, we can control the size and shape of the abrasive grains. Utilizing our expertise in chemical and additive formulation, we can modify our slurries to meet our customers’ various performance criteria. In Figure 1, it shows a test result example in which the removal rate of the Si-Face was improved. These improved performances depended on the type of additive used in the slurry. Test was performed using substrates of 4-inch 4H-N SiC (4°off) Si-face substrates with exactly the same polishing process and pad condition for all slurries. Slurry A was a result of high speed conventional slurry used by AIST [1] as a reference slurry. Slurry B was a newly developed slurry with improved abrasive grains dispersion. Slurry C was also a newly developed slurry focusing on the improvement of oxidation efficiency. As a result, it was possible to achieve a polishing removal rate over 2 um / hour as well as maintain low surface roughness at the same time. [1] S. Hirano et al., Journal of the Japan Society for Abrasive Technology, 60, (2016)353 Figure 1

To assess lung function and long-term respiratory outcomes in extremely low birth weight (ELBW) survivors.ELBW, especially with respiratory complications in the neonatal period, affects lung function at a later age.Longitudinal retrospective study.Lung function was evaluated in 89 ELBW survivors (at ages 8 and 12) with or without a history of bronchopulmonary dysplasia (BPD) or a bubbly/cystic lung appearance in the neonatal period.FVC, FEVLung function variables were significantly and positively correlated between 8 and 12 years: %FVC (RIn ELBW survivors, the obstructive pattern of lung function impairment deteriorated from 8 to 12 years of age, independent of the presence of severe BPD or bubbly/cystic appearance in the neonatal period.

Purpose To evaluate the long-term quality of life (QOL) of patients who had undergone major neonatal surgery, the psychosocial and cognitive consequences of neonatal surgical stress were assessed when the patients reached school age. Materials and methods Seventy-two patients who had undergone major neonatal surgery were enrolled in this study. Their primary diseases were anorectal malformation (ARM) in 27 cases, esophageal atresia (EA) in 23, and congenital diaphragmatic hernia (CDH) in 22. Intelligence tests using Wechsler Intelligence Scale for Children III (WISC-III) or a developmental test and the Child Behavior Checklist were conducted through questionnaires and interviews with clinical psychologists. Results Mental retardation (MR) was apparent in 25% of EA, 20% of ARM, and 18% of CDH, significantly higher than the 2% to 3% commonly found in the general population. The clinical range (CR) of the Child Behavior Checklist was seen in 35% of EA, 59% of ARM, and 38% of CDH, which is also significantly higher than the 25% typically seen in the general population. No significant differences in MR and CR were seen among the primary diseases. The most important factors influencing MR and CR remain to be identified. Conclusions To ensure true quality of life after neonatal surgical stress, pediatric surgeons must consider not only physical assessments but also cognitive, emotional, and psychosocial assessments.

In aging societies, there is a strong demand for robotics to tackle with problems caused by the aging population. Patient transfer, such as lifting and moving a bedridden patient from a bed to a wheelchair and back, is one of the most physically challenging tasks in nursing care, the burden of which should be reduced by the introduction of robot technologies. To this end, we have developed a new prototype robot named RIBA having human-type arms with tactile sensors. RIBA succeeded in transferring a human from a bed to a wheelchair and back. The tactile sensors play important roles in sensor feedback and detection of instructions from the operator. In this paper, after outlining the concept and specifications of RIBA, we will explain the tactile information processing, its application to tactile feedback and instruction detection, and safety measures to realize patient transfer. The results of patient transfer experiments are also reported.

Background: Long-term, prospective studies investigating the prevalence, serum IgE and the natural history of atopic dermatitis (AD) in a community are lacking. Methods: In a Japanese community, the skin of primary school children and junior high school students was examined and a questionnaire was given to their parents; their serum total IgE, and house dust mite (HDM)- and Japanese cedar pollen (JCP)-specific IgE levels were also assessed once a year for 9 years. Results: The median AD prevalence in all students (492 in 1998 and 380 in 2004) was 7.6% (6.1–10.4%). The prevalence and the area of skin eruptions of AD decreased with growth. Serum total and HDM-specific IgE levels were high in AD patients, and significant differences were noted for both levels between children with and without later remission of skin eruptions at the time of primary school entry. IgE level increases were noted in the following order: healthy skin < dry skin < AD. In children presenting only with dry skin without atopic disorders, such as AD, asthma and allergic rhinitis, levels of total HDM- and JCP-specific IgE were significantly higher than in children with healthy skin. Conclusions: The infantile IgE level serves as a prognostic index, and sensitization to inhalant allergens may be easily established in individuals with clinically dry skin, even when AD is not present, and this may lead to the development of atopic disorders.

The increased prevalence of atopic dermatitis (AD) in adults in recent decades suggests that dermatologists may be expected to estimate the prognosis of adult patients with AD when they visit as new patients. We therefore evaluated the change in the extent of involvement and analyzed the factors that contribute to the prognosis of adult AD. A retrospective chart review was performed for 65 adults patients (median age at first visit, 25 years) with AD who had been followed monthly for over 10 years. The median area of involvement at first visit was 19%. The area of the eruptions and peripheral eosinophil counts decreased significantly in the fifth and 10th years with standard treatment. The values of immunoglobulin (Ig)E were also reduced after 10 years. Patients with high values of serum total IgE and peripheral eosinophil count, and long duration of AD had wide areas of eruptions 10 years after the first visit. Total IgE had the highest correlation with area of involvement after 10 years. Although the prognosis of adult AD is not poor, patients with high IgE values are expected to have ongoing eczema with wide distribution after 10 years of follow up.

Human-interactive robots, such as those used for nursing, which share humans' environments and interact with them, should be covered with soft areal tactile sensors for safety and dexterous manipulation. We report the successful development of the tactile sensor system of our human-interactive robot named RI-MAN, which can lift up a dummy human.

The authors prepared the dimethyl and diphenyl esters of 9,9′-bianthryl-2,2′-dicarboxylic acid in racemic and enantiopure (M) forms. The enantiopure dimethyl ester forms inclusion compounds with various organic compounds such as benzene, methanol, phenol, and aniline whereas the racemic form does this only with benzene. No guest molecules are included by the racemic and enantiopure diphenyl esters. These effects of substituents and homochirality on the inclusion properties are discussed on the basis of X-ray structures of some inclusion and guest-free compounds. Chirality, 2008. © 2007 Wiley-Liss, Inc.

The ultimate goal of this research is to develop a robot that is able to perform physical tasks such as nursing care skillfully and safely in complex environment of our home and/or hospitals. In order to realize such a robot, the design criteria and approach should be different from that of traditional industrial robots. Specifically, considering the physical interactions between the robot and human subjects, the safety, ease and affinity are more important in addition to the robot's high power, speed and accuracy. Towards this objective, “RI-MAN” is developed in RIKEN BMC which demonstrated the high ability to carry up and hold a doll softly and safely. This paper first discusses the problems on the design of a human-interactive robot, and proposes original key technologies and system integration to solve the problems including the soft and whole body interaction. The details and basic performance of RI-MAN are then introduced together with some experimental results. The further research subjects are also pointed.

Background Since 1982, viable cells of Bifidobacterium breve, BBG-01, have been used in clinical conditions in pediatric patients such as intractable infantile diarrhea, preterm infants, and pediatric surgical patients. Although the efficacy of BBG-01 has been widely reported, adverse events related to the use of BBG-01 have been reported in very few cases. Methods In order to trace adverse events seen by 109 doctors in 88 medical institutions where BBG-01 was used, a questionnaire survey of the number of occurrences and details of each case was conducted. Results Eighty-six clinicians (70 institutions) responded to the questionnaire; the response rate was 78.9%. The number of respondents classified by the department of diagnosis (the number of BBG-01 treated infants) was pediatrics, 29 respondents (10,938 patients); premature and newborn medicine, 26 (10,677); Obstetrics and Gynecology, 1 (1,212) and pediatric surgery, 22 (169). More than 90% of the total BBG-01-treated patients (23,092 patients) were in the departments of premature and newborn medicine and pediatrics, and BBG-01 had been used mainly in preterm infants and children with intractable diarrhea. Adverse events occurred in two extremely premature infants with functional ileus due to vehicle as starch aggregates and two surgical neonates with bacteremia caused by B. breve genetically identical to BBG-01, and no serious adverse events with a poor outcome were reported. Thus the results of the present questionnaire survey indicate that adverse events related to the use of BBG-01 have an extremely low incidence and are mild in severity, ensuring superior safety of this preparation. This article is protected by copyright. All rights reserved.

Our previous studies of long-term QOL after major neonatal surgery revealed an unexpectedly high incidence of mental retardation as well as emotional and psychosocial problems, and the patients' QOL correlated with maternal QOL and post-traumatic stress disorder (PTSD). The main purpose of this study was to clarify the risk factors affecting long-standing maternal PTSD.Sixty-eight patients, aged between 6 and 17years, and their mothers were enrolled in this study. The underlying diseases included congenital diaphragmatic hernia in 21, anorectal anomalies in 25 and esophageal atresia in 22. Psychoanalysts carried out intelligence tests, the Child Behavior Checklist and QOL evaluation in the patients. QOL was evaluated with WHOQOL26 and PTSD with IES-R questionnaires in their mothers. The mothers were divided into two groups; low- and high-risk groups according to PTSD score.Patient QOL scores correlated positively with maternal QOL (p0.05) and negatively with maternal PTSD scores (p0.05). There were significant differences in total number of hospital admissions (p0.05), feeling of economic burden (p0.05), and satisfaction with husband's help (p0.01) between the two groups.Risk factors for maternal PTSD include repeated hospitalization, a feeling of economic burden, and lack of satisfaction with husband's help.