title: Hepatoblastoma in children of extremely low birth weight: a report from a single perinatal center.
abstract: OBJECTIVE
  The incidence of hepatoblastoma (HB) in children of low birth weight is increasing. In the authors' institute, 5 infants of extremely low birth weight (ELBW) were found to have HB. The purpose of this study was to identify the characteristics of these infants to elucidate the pathogenesis of HB arising in ELBW infants.
  
  
  METHODS
  Birth weight (BW) ranged from 554 to 750 g (mean, 654 g) and gestational age from 23 to 29 weeks (mean, 25.8 weeks). Medical records of the 5 patients were reviewed, and perinatal treatments were compared with those of ELBW infants without HB.
  
  
  RESULTS
  One patient with intraabdominal hemorrhage had emergency operation, which was followed by early postoperative death. The parents of one child refused treatment because of associated severe anomalies. He died of the growing tumor 4 months after diagnosis. The remaining 3 patients had radical operation performed after intraarterial chemoembolization and systemic chemotherapy. One died of hepatic failure 7 months after operation. Two are alive 5 and 9 months after operation. The incidence of HB among ELBW infants was estimated to be about 0.5% in our institute. The mean durations of mechanical ventilation, oxygen inhalation, and hospitalization during the neonatal periods in cases of HB were significantly longer than those in BW matched control infants (P <.01).
  
  
  CONCLUSIONS
  ELBW children have a high risk for HB. In follow-up of ELBW infants, serum alpha-fetoprotein or abdominal ultrasonography may be useful to detect early HB. The children with HB received perinatal treatments for a significantly longer time, which suggests that perinatal intensive and long-term medical treatments may be involved in the tumorigenesis in the highly sensitive immature liver.
authors.affiliation: Department of Pediatric Surgery, Pediatrics and Neonatology, Osaka Medical Center & Research Institute for Maternal & Child Health, Izumi, Osaka, Japan.
authors.forename: Takaharu
authors.initials: T
authors.lastname: Oue
authors.forename: Akio
authors.initials: A
authors.lastname: Kubota
authors.forename: Hiroomi
authors.initials: H
authors.lastname: Okuyama
authors.forename: Hisayoshi
authors.initials: H
authors.lastname: Kawahara
authors.forename: Keigo
authors.initials: K
authors.lastname: Nara
authors.forename: Keisei
authors.initials: K
authors.lastname: Kawa
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kitajima
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D016461:Chemoembolization, Therapeutic / Q000379:methods; D005260:Female; D005865:Gestational Age; D018197:Hepatoblastoma / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000628:therapy; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D019102:Infant, Very Low Birth Weight; D008113:Liver Neoplasms / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000628:therapy; D008297:Male; D018743:Perinatal Care / Q000379:methods