乳児期早期に確定診断したPrader-Willi症候群の1女児例

症例は在胎36週で出生した女児である.胎児期から羊水過多を指摘され,生直後から重度の筋緊張低下があり,啼泣や体動はほとんど認められなかった.酸素投与は不要であったが,呼吸補助のため経鼻的陽圧換気を要した.また,嚥下運動がみられず,栄養管理は経鼻胃管を要した.本児はFloppy infantであり,当初は神経筋疾患が疑われた.人工呼吸器や経管栄養の離脱に時間を要したが,筋症状が緩徐に改善したことがPWSを鑑別する契機になった.遺伝学的検査ではDNAメチル化試験が本児の診断に有用で,時間経過とともに症状が改善したことに留意し,PWSを乳児期早期に確定診断できたと考えられた....

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Published in昭和学士会雑誌 Vol. 80; no. 6; pp. 557 - 562
Main Authors 櫻井, 基一郎, 阿部, 祥英, 高瀬, 眞里子, 櫻井, 裕子, 青木, 真史, 江畑, 晶夫
Format Journal Article
LanguageJapanese
Published 昭和大学学士会 2020
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ISSN2187-719X
2188-529X
DOI10.14930/jshowaunivsoc.80.557

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Abstract 症例は在胎36週で出生した女児である.胎児期から羊水過多を指摘され,生直後から重度の筋緊張低下があり,啼泣や体動はほとんど認められなかった.酸素投与は不要であったが,呼吸補助のため経鼻的陽圧換気を要した.また,嚥下運動がみられず,栄養管理は経鼻胃管を要した.本児はFloppy infantであり,当初は神経筋疾患が疑われた.人工呼吸器や経管栄養の離脱に時間を要したが,筋症状が緩徐に改善したことがPWSを鑑別する契機になった.遺伝学的検査ではDNAメチル化試験が本児の診断に有用で,時間経過とともに症状が改善したことに留意し,PWSを乳児期早期に確定診断できたと考えられた.
AbstractList 症例は在胎36週で出生した女児である.胎児期から羊水過多を指摘され,生直後から重度の筋緊張低下があり,啼泣や体動はほとんど認められなかった.酸素投与は不要であったが,呼吸補助のため経鼻的陽圧換気を要した.また,嚥下運動がみられず,栄養管理は経鼻胃管を要した.本児はFloppy infantであり,当初は神経筋疾患が疑われた.人工呼吸器や経管栄養の離脱に時間を要したが,筋症状が緩徐に改善したことがPWSを鑑別する契機になった.遺伝学的検査ではDNAメチル化試験が本児の診断に有用で,時間経過とともに症状が改善したことに留意し,PWSを乳児期早期に確定診断できたと考えられた.
Author 阿部, 祥英
青木, 真史
櫻井, 基一郎
櫻井, 裕子
高瀬, 眞里子
江畑, 晶夫
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References 5) Singh P, Mahmoud R, Gold JA, et al. A multicenter study of maternal and neonatal outcomes in individuals with Prader-Willi syndrome. J Med Genet. 2018;55:594-598.
9) Tuysuz B, Kartal N, Erener-Ercan T, et al. Prevalence of Prader-Willi syndrome among infants with hypotonia. J Pediatr. 2014;164:1064-1067.
10) Kimonis VE, Tamura R, Gold JA, et al. Early Diagnosis in Prader-Willi syndrome reduces obesity and associated co-morbidities. Genes (Basel). 2019;10:898. (accessed 2020 Feb 23)https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6896038/pdf/genes-10-00898.pdf
6) Adamczyk M, Komacki J, Wirstlein P, et al. Follow-up of children with antenatally diagnosed idiopathic polyhydramnios. Ginekol Pol. 2019;90:93-99.
8) Bar C, Diene G, Molinas C, et al. Early diagnosis and care is achieved but should be improved in infants with Prader-Willi syndrome. Orphanet J of Rare Dis. 2017;12:118. (accessed 2020 Feb 12) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5490212/pdf/13023_2017_Article_673.pdf
2) Prasad AN, Prasad C. The floppy infant: contribution of genetic and metabolic disorders. Brain Dev. 2003;25:457-476.
4) Yang L, Zhou Q, Ma B, et al. Perinatal features of Prader-Willi syndrome: a Chinese cohort of 134 patients. Orphanet J of Rare Dis. 2020;15:24. (accessed 2020 Feb 12) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6975078/pdf/13023_2020_Article_1306.pdf
1) Butler MG, Miller JL, Forster J. Prader-Willi syndrome-Clinical genetics, diagnosis and treatment approaches: an update. Curr Pediatr Rev. 2019;15:207-244.
7) Gross N, Rabinowitz R, Gross-Tsur V, et al. Prader-Willi syndrome can be diagnosed prenatally. Am J of Med Genet A. 2015;167A:80-85.
11) Cizmecioglu FM, Jones JH, Paterson WF, et al. Neonatal features of the Prader-Willi syndrome; the case making the diagnosis during the first week of life. J Clin Res Pediatr Endocrinol. 2018;10:264-273.
3) Laugel V, Cossee M, Matis J, et al. Diagnostic approach to neonatal hypotonia: retrospective study on 144 neonates. Eur J Pediatr. 2008;167:517-523.
References_xml – reference: 4) Yang L, Zhou Q, Ma B, et al. Perinatal features of Prader-Willi syndrome: a Chinese cohort of 134 patients. Orphanet J of Rare Dis. 2020;15:24. (accessed 2020 Feb 12) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6975078/pdf/13023_2020_Article_1306.pdf
– reference: 5) Singh P, Mahmoud R, Gold JA, et al. A multicenter study of maternal and neonatal outcomes in individuals with Prader-Willi syndrome. J Med Genet. 2018;55:594-598.
– reference: 7) Gross N, Rabinowitz R, Gross-Tsur V, et al. Prader-Willi syndrome can be diagnosed prenatally. Am J of Med Genet A. 2015;167A:80-85.
– reference: 8) Bar C, Diene G, Molinas C, et al. Early diagnosis and care is achieved but should be improved in infants with Prader-Willi syndrome. Orphanet J of Rare Dis. 2017;12:118. (accessed 2020 Feb 12) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5490212/pdf/13023_2017_Article_673.pdf
– reference: 9) Tuysuz B, Kartal N, Erener-Ercan T, et al. Prevalence of Prader-Willi syndrome among infants with hypotonia. J Pediatr. 2014;164:1064-1067.
– reference: 1) Butler MG, Miller JL, Forster J. Prader-Willi syndrome-Clinical genetics, diagnosis and treatment approaches: an update. Curr Pediatr Rev. 2019;15:207-244.
– reference: 10) Kimonis VE, Tamura R, Gold JA, et al. Early Diagnosis in Prader-Willi syndrome reduces obesity and associated co-morbidities. Genes (Basel). 2019;10:898. (accessed 2020 Feb 23)https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6896038/pdf/genes-10-00898.pdf
– reference: 3) Laugel V, Cossee M, Matis J, et al. Diagnostic approach to neonatal hypotonia: retrospective study on 144 neonates. Eur J Pediatr. 2008;167:517-523.
– reference: 6) Adamczyk M, Komacki J, Wirstlein P, et al. Follow-up of children with antenatally diagnosed idiopathic polyhydramnios. Ginekol Pol. 2019;90:93-99.
– reference: 2) Prasad AN, Prasad C. The floppy infant: contribution of genetic and metabolic disorders. Brain Dev. 2003;25:457-476.
– reference: 11) Cizmecioglu FM, Jones JH, Paterson WF, et al. Neonatal features of the Prader-Willi syndrome; the case making the diagnosis during the first week of life. J Clin Res Pediatr Endocrinol. 2018;10:264-273.
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Snippet 症例は在胎36週で出生した女児である.胎児期から羊水過多を指摘され,生直後から重度の筋緊張低下があり,啼泣や体動はほとんど認められなかった.酸素投与は不...
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StartPage 557
SubjectTerms DNAメチル化解析
Prader-Willi症候群
神経筋疾患
筋緊張低下
Title 乳児期早期に確定診断したPrader-Willi症候群の1女児例
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