Faculty Profiles - Kazuhiro Uda

Papers - Kazuhiro Uda

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小児咽後膿瘍の臨床的特徴 Reviewed

塚本淳也, 宇田和宏, 矢野瑞季, 荒木孝太郎, 福岡かほる, 松島崇浩, 鈴木知子, 榊原裕史, 幡谷浩史, 堀越裕歩

小児感染免疫 32 ( 1 ) 19 - 26 2020.2

Acute Rheumatic Fever and Kawasaki Disease Occurring in a Single Patient. Reviewed International journal

Kazuki Iio, Naoya Fukushima, Keiji Akamine, Kazuhiro Uda, Hiroshi Hataya, Masaru Miura

Frontiers in pediatrics 8 562 - 562 2020

Language：English

Kawasaki disease and acute rheumatic fever are two major causes of acquired heart disease in the pediatric population. Although both conditions are well-known entities, the association between them has never been described. We report herein a case of 6-year-old male patient who first presented with Kawasaki shock syndrome, followed by acute rheumatic fever 1 year later. In contrast to the prompt intervention given for atypical Kawasaki disease, in the present case the diagnosis was significantly delayed during the otherwise typical presentation of acute rheumatic fever. Our case highlights the difficulty experienced by many pediatricians in developed nations in diagnosing acute rheumatic fever due to its comparative rarity. To prevent diagnostic errors, all pediatricians should be alert to the possibility of acute rheumatic fever even if they are practicing in areas where it is not endemic.

DOI： 10.3389/fped.2020.00562

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Prolonged PR interval in a patient with acute rheumatic fever. Reviewed International journal

K Uda, Y Horikoshi, M Miura

QJM : monthly journal of the Association of Physicians 112 ( 10 ) 817 - 818 2019.10

Multifocal Infantile Hemangioma. Reviewed International journal

Kazuhiro Uda, Yusuke Okubo, Takahiro Matsushima, Chieko Sadahira, Tatsuo Kono, Hiroshi Hataya

The Journal of pediatrics 210 238 - 238 2019.7

Caterpillar Sign in an Infant with Hypertrophic Pyloric Stenosis. Reviewed International journal

Reiko Kawai, Kazuhiro Uda, Yuho Horikoshi, Hiroshi Hataya

The Journal of pediatrics 208 292 - 292 2019.5

Nationwide study of outpatient oral antimicrobial utilization patterns for children in Japan (2013-2016). Reviewed International journal

Noriko Kinoshita, Naho Morisaki, Kazuhiro Uda, Masashi Kasai, Yuho Horikoshi, Isao Miyairi

Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy 25 ( 1 ) 22 - 27 2019.1

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: Antimicrobial resistance (AMR) is a major multinational public health concern. The Japanese government set goals in its AMR action plan to reduce use of oral cephalosporins, macrolides, and quinolones by half between 2013 and 2020. We aimed to evaluate antimicrobial use in children in Japan by observing prescription patterns as an interim assessment of the national AMR action plan. METHODS: Using the national health claims database, we retrospectively analyzed all oral antimicrobials dispensed from outpatient pharmacies in Japan to children under 15 years old from 2013 to 2016 by age, prefecture, type of antimicrobial, and year. Data were presented as days of therapy (DOTs) per 1000 pediatric inhabitants per day (DOTs/PID). The χ2 test for trends was performed to evaluate annual changes in DOTs/PID overall as well as within each stratum. RESULTS: A total of 721,627,553 oral antimicrobial DOTs were identified during 2013-2016. No statistically significant changes were observed in total antimicrobial use in children (2013: 28.54 DOTs/PID; 2016: 28.70 DOTs/PID; Ptrend = 0.25) and amount of cephalosporins, macrolides, and quinolones prescribed. Prescription rates of all antimicrobials were highest among children 1-5 years old, peaking at 1 year old. Targeted antimicrobials for the AMR action plan showed similar distribution by age. CONCLUSION: The amount of antimicrobials prescribed to children in Japan is not decreasing. Overall antimicrobial prescriptions, as well as prescriptions of cephalosporins, macrolides, and quinolones, were most prevalent in children ≤5 years old. Rigorous antimicrobial stewardship interventions targeting infants and younger children are necessary.

DOI： 10.1016/j.jiac.2018.10.002

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Ototoxicity and Nephrotoxicity With Elevated Serum Concentrations Following Vancomycin Overdose: A Retrospective Case Series. Reviewed International journal

Kazuhiro Uda, Junichi Suwa, Kenta Ito, Hiroshi Hataya, Yuho Horikoshi

The journal of pediatric pharmacology and therapeutics : JPPT : the official journal of PPAG 24 ( 5 ) 450 - 455 2019

Language：English

Although a high vancomycin serum concentration is known to be associated with nephrotoxicity, its association with ototoxicity is not well known. The purpose of our study was to examine the latter association in pediatric patients, especially in cases of accidental overdose. Pediatric patients who received vancomycin at our facility between March 2010 and December 2015 with a serum trough concentration > 30 mg/L were enrolled. Age, sex, neonatal hearing screening results, estimated peak vancomycin serum concentration, duration of drug exposure, renal function, and hearing test results were collected. The estimated duration of concentrations above 30 or 80 mg/L were simulated with the Sawchuk-Zaske method. We defined a "high concentration" and "toxic concentration" of vancomycin as 30 to 80 mg/L and > 80 mg/L, respectively. Ototoxicity was assessed based on the auditory brain stem response. We identified 4 females and 2 males with normal hearing at birth. Four of the 6 patients were ≤ 3 months old. All the patients reached an estimated peak serum concentration of > 80 mg/L, and 5 exceeded 150 mg/L. The estimated duration of exposure to a high concentration and toxic concentration of vancomycin was 15 to 62 hours and 8 to 43 hours, respectively. All the patients experienced transient renal dysfunction. Although transient ototoxicity was found in 1 patient, prolonged ototoxicity was not observed in any of the patients. All the patients had received an accidental overdose of vancomycin. Prolonged hearing loss due to a high vancomycin serum concentration was not found in any of the subjects in the present report.

DOI： 10.5863/1551-6776-24.5.450

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Hamman's Sign in a Patient with Spontaneous Pneumomediastinum. Reviewed International journal

Kazuhiro Uda, Takahiro Matsushima, Yuho Horikoshi, Hiroshi Hataya

The Journal of pediatrics 202 324 - 324 2018.11

Multiple Bullae Associated with Human Parvovirus B19. Reviewed International journal

Shoko Yoshii, Kazuhiro Uda, Isao Miyairi, Hiro Nakao, Naoko Kono, Mitsuru Kubota, Akira Ishiguro

The Journal of pediatrics 202 327 - 327 2018.11

Ultrasound-guided peripheral intravenous access placement for children in the emergency department. Reviewed International journal

Takehito Otani, Yoshihiko Morikawa, Itaru Hayakawa, Yukari Atsumi, Kouki Tomari, Yutaro Tomobe, Kazuhiro Uda, Yu Funakoshi, Chiho Sakaguchi, Shizuka Nishimoto, Hiroshi Hataya

European journal of pediatrics 177 ( 10 ) 1443 - 1449 2018.10

Language：English Publishing type：Research paper (scientific journal)

The usefulness of ultrasound guidance in peripheral intravenous access placement has yet to be established in children. In this prospective comparative study, we investigated success rates of intravenous access placement with ultrasound guidance in a pediatric emergency department. After a failed first attempt with the conventional technique, the second and third attempts were conducted using either the ultrasound guidance (a real-time, dual operator method) or the conventional technique. The success rates within the two interventional attempts were then compared. From a total of 712 participants, those with a failed first attempt were allocated to the ultrasound guidance (n = 99) and conventional technique (n = 100) groups. The success rate was significantly lower for the ultrasound guidance (65%) than for the conventional technique (84%) group (p = 0.002, chi-square test). This remained significant after adjusting for confounders with multiple logistic regression analysis (odds ratio 2.60, 95% confidence interval 1.26-5.37, p = 0.001). CONCLUSION: Ultrasound-guided intravenous access placement using a real-time, dual operator method led to a significantly lower success rate than the conventional technique in children with one failed conventional attempt in the emergency department. TRIAL REGISTRATION: UMIN000014730 What is Known: • Children experience a low success rate (about 60% with 1 attempt and about 90% with 4 attempts) for IV access placement. • Ultrasound guidance may lead to a decreased number of attempts and shorter procedural time with comparable overall IV success rate. What is New: • Ultrasound-guided IV placement (a real-time, dual operator method) actually led to a significantly lower IV success rate than the conventional technique in children in the emergency department. • Our result warrants further trials to determine the precise population who benefits from ultrasound guidance.

DOI： 10.1007/s00431-018-3201-3

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WU polyomavirus detected in children with severe respiratory failure. Reviewed International journal

Kazuhiro Uda, Chitose Koyama-Wakai, Kensuke Shoji, Noriyasu Iwase, Daisuke Motooka, Shota Nakamura, Isao Miyairi

Journal of clinical virology : the official publication of the Pan American Society for Clinical Virology 107 25 - 28 2018.10

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: WU polyomavirus (WUPyV) is a relatively new virus associated with respiratory infections. However, its role is unclear in children with severe respiratory failure. OBJECTIVES: We aimed to evaluate the characteristics of severe respiratory failure associated with WUPyV infection in children. STUDY DESIGN: We retrospectively reviewed cases of respiratory tract infection at a tertiary children's hospital in Japan and performed real-time polymerase chain reaction (PCR) for WUPyV using residual extracted nucleic acid samples taken from respiratory tract samples of pediatric patients primarily with respiratory failure. We investigated the clinical characteristics of patients positive for WUPyV and assessed samples positive for WUPyV for other respiratory pathogens using multiplex PCR. RESULTS: WUPyV was detected in 14 of 318 specimens of respiratory tract infections. The median age was 34 months and males were predominant (n = 11, 64%). An underlying disease was found in 11 (79%) patients including five preterm and three immunocompromised patients. The most common clinical diagnosis was pneumonia (n = 13, 93%). The majority of the samples were endotracheal tube aspirates (n = 11, 79%). Other viruses were co-detected in nine (64%) patients, while WUPyV was the only pathogen detected in five patients with a history of admission to the neonatal intensive care unit. These five patients presented with fever and cough, and perihilar infiltrates were detected on chest radiograph in several days. CONCLUSIONS: WUPyV was detected in children with severe respiratory failure independently or concurrently with other pathogens. WUPyV can be a pathogen for children with a history of preterm birth or an underlying disease.

DOI： 10.1016/j.jcv.2018.08.003

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Clinical characteristics of influenza virus-induced lower respiratory infection during the 2015 to 2016 season. Reviewed International journal

Kazuhiro Uda, Kensuke Shoji, Chitose Koyama-Wakai, Munehiro Furuichi, Noriyasu Iwase, Seiichiro Fujisaki, Shinji Watanabe, Isao Miyairi

Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy 24 ( 6 ) 407 - 413 2018.6

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: Influenza A(H1N1)pdm09 virus infections often manifest severe respiratory symptoms, particularly in patients with a past history of allergic disease. Most of these findings were reported during the 2009 pandemic. The purpose of this study was to detail the clinical characteristics of influenza virus-induced lower respiratory infection (LRI) during the A(H1N1)pdm09-predominant 2015-2016 season. METHODS: We retrospectively reviewed the clinical characteristics of influenza-induced LRI cases in children admitted to a tertiary children's hospital. Molecular diagnostic evaluation was performed on samples obtained from the most severe cases. RESULTS: We identified 66 patients with influenza-associated hospitalization and included 21 patients with influenza virus-induced LRI for analyses. Twelve patients (57%) were admitted to the pediatric intensive care unit, seven (33%) required mechanical ventilation, and three (14%) required extracorporeal membrane oxygenation. Plastic bronchitis (PB) was identified in six patients (29%), among whom a past medical history of asthma or food allergy were noted in all six patients. A past history of allergic disease was more common among patients with, than among those without, PB (p = 0.009). A(H1N1)pdm09 was detected from all the PB cases, and phylogenetic analyses of the hemagglutinin and neuraminidase genes demonstrated that this virus belonged to subclades 6B.1 and 6B.2. In the six PB cases, we found one patient with H275Y mutation in neuraminidase. CONCLUSION: Allergic disease was a risk factor for developing PB due to influenza A(H1N1)pdm09 infection during the 2015-16 season.

DOI： 10.1016/j.jiac.2018.01.002

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Trends of neuraminidase inhibitors use in children with influenza related respiratory infections. Reviewed International journal

Kazuhiro Uda, Yusuke Okubo, Kensuke Shoji, Isao Miyairi, Naho Morisaki, Nobuaki Michihata, Hiroki Matsui, Kiyohide Fushimi, Hideo Yasunaga

Pediatric pulmonology 53 ( 6 ) 802 - 808 2018.6

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: Neuraminidase inhibitors are recommended for children hospitalized with influenza-related respiratory infections, and oseltamivir is the first choice of treatment in most situations. However, little is known regarding the recent trend in using neuraminidase inhibitors and their difference in health economy. The aim of this study was to reveal recent trends in neuraminidase inhibitor use and compare hospitalization costs across different treatment regimens. METHODS: We retrospectively obtained the hospital discharge records of inpatients under 18 years of age with a diagnosis of influenza-related respiratory infections using a national inpatient database in Japan. We excluded patients with chronic medical conditions from the analyses. Multivariable mixed effects regression models were used to investigate the recent treatment trends and healthcare costs. RESULTS: We identified 27 771 inpatients with influenza-related respiratory infections. The proportions of neuraminidase inhibitor use increased from 62.6% in 2010 to 71.8% in2014 (Ptrend < 0.001). Correspondingly, the proportions of peramivir use showed an upward trend, ranging from 31.4% to 57.4% (Ptrend < 0.001). In contrast, proportions of oseltamivir and zanamivir use decreased from 26.1% to 12.1% and from 4.9% to 1.5%, respectively (Ptrend < 0.001). Laninamivir use did not change over the period. Total hospitalization costs were higher in the peramivir group than in the oseltamivir group (adjusted difference, $84.3; 95%CI, $70.7-$98.4). CONCLUSIONS: We observed an increasing trend in peramivir use and decreasing trends in use of oseltamivir and zanamivir. Treatment with peramivir required higher hospitalization costs.

DOI： 10.1002/ppul.24021

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Recent trends in practice patterns and impact of corticosteroid use on pediatric Mycoplasma pneumoniae-related respiratory infections. Reviewed International journal

Yusuke Okubo, Nobuaki Michihata, Naho Morisaki, Kazuhiro Uda, Isao Miyairi, Yuichi Ogawa, Hiroki Matsui, Kiyohide Fushimi, Hideo Yasunaga

Respiratory investigation 56 ( 2 ) 158 - 165 2018.3

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: Mycoplasma pneumoniae is a major pathogen causing community-acquired pneumonia/bronchitis in children, and macrolide-resistant strains are increasing in East Asian countries. Recent practice patterns, especially for antibiotic selection, and benefits of corticosteroid treatment in pediatric Mycoplasma pneumoniae infections remain unclear. METHODS: Using the Japanese Diagnosis Procedure Combination inpatient database, we analyzed recent trends in antibiotic selection and corticosteroid use for pediatric Mycoplasma pneumoniae-related respiratory infections, using multivariable mixed effects logistic regressions. In addition, we compared hospital utilization and readmission between children who received corticosteroids and those who did not, using propensity-score matching and instrumental variable analyses. RESULTS: Overall, 51,633 inpatients were identified. From 2010 to 2014, the use of macrolides and lincosamides decreased from 62.8% to 50.6% and from 25.6% to 13.7% respectively (Ptrend < 0.001), whereas fluoroquinolone use increased from 4.6% to 22.6% (Ptrend < 0.001). Tetracycline use did not demonstrate a significant change in trend. Propensity score matching analysis showed that hospital stay in the steroid group was 0.90 days longer than in the non-steroid group (95% confidence interval, 0.84-0.96). Total hospitalization cost was higher in the steroid compared to the non-steroid group (57.6 US dollars; 95% CI, 48.8-66.8). A significant difference in 30-day readmission risk was observed between the steroid (1.6%) and non-steroid (1.2%) groups (risk difference 0.4%; 95% CI, 0.1-0.7%). Similar results were observed on instrumental variable analyses. CONCLUSIONS: Increasing trends in fluoroquinolone use and decreasing trends in macrolide use were observed. Our study did not prove the benefits of corticosteroid use. Further studies are required to confirm the clinical benefits of corticosteroid treatment.

DOI： 10.1016/j.resinv.2017.11.005

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Dose-response relationship between weight status and clinical outcomes in pediatric influenza-related respiratory infections. Reviewed International journal

Yusuke Okubo, Nobuaki Michihata, Kazuhiro Uda, Naho Morisaki, Isao Miyairi, Hiroki Matsui, Kiyohide Fushimi, Hideo Yasunaga

Pediatric pulmonology 53 ( 2 ) 218 - 223 2018.2

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: Associations between underweight/obesity and manifestations of influenza infection remain unclear, especially in children. This study investigated the dose-response relationships between weight status and clinical outcomes among children hospitalized with influenza-related respiratory infections. METHODS: We obtained hospital discharge records of inpatients aged under 18 years with diagnoses of bronchitis/pneumonia and influenza, using a Japanese national inpatient database. The patients were classified as underweight, normal-weight, overweight, or obese groups using weight-for-length, weight-for-height, and body-mass-index for age following World Health Organization criteria. We compared need for intensive care, 30-day readmission, mean total hospitalization costs, and length of hospital stay across the four groups using multivariable regression models and restricted cubic spline functions. RESULTS: Overall, 27 771 patients were identified, including 2637 underweight, 19 701 normal-weight, 2675 overweight, and 2758 obese patients. The underweight group showed a significantly higher 30-day readmission (adjusted odds ratio, 1.68; 95% confidence interval, 1.28-2.18) and a longer length of stay (adjusted difference, 0.23 days; 95% confidence interval, 0.12-0.23 days) than the normal-weight group did. No significant differences in the need for intensive care or hospitalization costs were observed across the four weight status groups. The threshold for a statistically significant association between weight status and 30-day readmission was a z-score for weight-for-length, weight-for-height, or BMI for age of -0.95 (17th percentile). CONCLUSION: These findings demonstrated that underweight status is a risk factor for repeated hospital admissions because of influenza-related respiratory infections in children.

DOI： 10.1002/ppul.23927

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Pertussis without apparent cough in a disabled girl with a tracheostomy. Reviewed International journal

Hisataka Nozawa, Kensuke Shoji, Kazuhiro Uda, Tomoo Nakamura, Mitsuru Kubota, Akira Ishiguro, Isao Miyairi

Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy 23 ( 11 ) 782 - 784 2017.11

Language：English Publishing type：Research paper (scientific journal)

Pertussis is characterized by intense, prolonged coughing in children often followed by a distinctive whooping sound on inspiration. However, the clinical manifestations and natural course of pertussis in disabled children are largely unknown. We experienced a case of pertussis in a disabled girl who had previously undergone a tracheostomy and laryngotracheal separation. She presented with increased tracheal secretions and required hospitalization but did not develop a cough. Pertussis was suspected from the sputum Gram stain, which revealed numerous, short gram-negative rods that did not grow on chocolate agar. A nucleic acid amplification test was positive for Bordetella pertussis and the patient improved on azithromycin. Pertussis may present without its cardinal symptoms in disabled children.

DOI： 10.1016/j.jiac.2017.05.007

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Pulmonary Calcification in a Congenital Cytomegalovirus Infection. Reviewed International journal

Kazuhiro Uda, Yuka Sasaki, Kensuke Shoji, Isao Miyairi

The Journal of pediatrics 190 286 - 286 2017.11

Febrile status epilepticus due to respiratory syncytial virus infection. Reviewed International journal

Kazuhiro Uda, Katsuhiko Kitazawa

Pediatrics international : official journal of the Japan Pediatric Society 59 ( 8 ) 878 - 884 2017.8

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: Febrile status epilepticus can have neurological sequelae. The type of sequelae, however, depend on the etiology, including infection due to viral agents such as the influenza virus. Respiratory syncytial virus (RSV) infection in childhood may also contribute to this. The aim of this study was therefore to characterize febrile status epilepticus associated with RSV infection, and to determine whether this type of infection is a risk factor for neurological sequelae in febrile status epilepticus. METHODS: We reviewed the medical records of children aged ≤3 years with febrile status epilepticus who were admitted to a tertiary hospital between January 2007 and December 2011. The differences between the RSV-positive and RSV-negative groups were evaluated according to the demographic and clinical data. RESULTS: A total of 99 patients with febrile status epilepticus who had been tested for RSV infection were identified. Three patients in the RSV-positive group (n = 19) and four in the RSV-negative group (n = 80) presented with bronchiolitis. The incidence of intubation and anti-seizure drug treatment in the RSV-positive group was significantly higher than in the -negative group. While all of the patients in the RSV-negative group recovered completely, six patients in the RSV-positive group developed encephalopathy and profound neurological sequelae. In five of the six patients, diffusion-weighted magnetic resonance imaging showed subcortical white matter lesions. CONCLUSIONS: RSV infection in the absence of bronchiolitis can initially present as febrile status epilepticus and subsequently develop into acute encephalopathy with profound neurological sequelae.

DOI： 10.1111/ped.13300

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Early diagnosis of scurvy based on radiology and dietary history. Reviewed International journal

Kazuhiro Uda, Masahiro Goto, Ayako Nigo, Tatsuo Kono

Pediatrics international : official journal of the Japan Pediatric Society 59 ( 3 ) 357 - 358 2017.3

Ulceration at Bacillus Calmette-Guérin Inoculation Site in a Patient with Kawasaki Disease. Reviewed International journal

Kazuhiro Uda, Hiroshi Hataya

The Journal of pediatrics 167 ( 5 ) 1167 - 7 2015.11

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Papers - Kazuhiro Uda