Kawasaki disease in infants less than one year of age,☆☆,

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Abstract

Objective: To identify risk factors for severe sequelae, analyze disease characteristics, and assess efficacy of intravenously administered immune globulin (IVGG) therapy in infants less than 12 months of age with Kawasaki disease. Design: Retrospective chart review of children less than 12 months of age with Kawasaki disease between 1980 and 1993. Results: Of 443 patients with Kawasaki disease, 57 (13%) were less than 1 year of age, including 14 (3%) less than 6 months. Age at onset was a predictor of the development of coronary artery aneurysms (CAA) and of giant (>8 mm) aneurysms: 11 (79%) of 14 children <6 months and 17 (44%) of 39 children 6 to 12 months of age acquired CAA (p = 0.06), and 5 (37%) of 14 children <6 months and 2 (5%) of 39 children 6 to 12 months of age acquired giant CAA (p <0.01). No specific clinical or laboratory features predicted the development of CAA, which was found in 7 (29%) of 24 patients treated with IVGG by illness day 10 and in 21 (73%) of 29 patients treated after day 10 or never treated with IVGG (p <0.01). Only 1 (4%) of 24 patients treated by day 10 but 6 (21%) of 29 children treated after day 10 or never treated with IVGG acquired giant CAA (p = 0.01). Persistent (>1 year) CAA were present in 4 (17%) of 24 IVGG-treated children by day 10 and in 14 (48%) of 29 children not treated by day 10 or never treated with IVGG (p <0.025). There was no difference in outcome if IVGG was given by illness day 7 or on illness days 8 to 10. Conclusions: Patients with Kawasaki disease less than 6 months of age are at particularly increased risk of having CAA and giant CAA. Therapy with IVGG, given by illness day 10, is associated with substantial reduction in the frequency of CAA and giant CAA in this high-risk population. (J PEDIATR 1995;126:524-9)

Section snippets

METHODS

We performed a retrospective chart review of patients less than 1 year of age at the onset of KD diagnosed at Children's Memorial Hospital (CMH), Chicago, from 1980 to 1993 inclusive. Demographic, clinical, laboratory, echocardiographic, therapeutic, and follow-up data were extracted from each medical record. Typical KD was diagnosed by the presence of fever for 5 or more days with at least four of five criteria,1 or fever plus three major criteria if CAA were recognized by echocardiography.4

RESULTS

Fifty-seven patients less than 1 year of age at the on set of KD were identified by medical record search and review of records of the division of infectious diseases. Three patients were lost to follow-up shortly after their acute illness, and one medical record was unavailable; data from the remaining 53 patients were analyzed. The 57 patients represent 13% of the total number of 443 patients with KD who were cared for at CMH during this period. No patients with known cardiac complications

DISCUSSION

This retrospective review of KD in infants less than 1 year of age extends information reported in non-age-restricted reports9 and in the few articles limited to this particular age group.3, 10, 11 We arbitrarily divided our patients into those <6 months and those >6 months of age to be consistant with previous reports.3, 10, 11 We failed to identify risk factors that predicted development of CAA in this population. Young age at the onset of KD, however, predicted the development of CAA in that

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From the Department of Pediatrics, Northwestern University Medical School, Division of Infectious Diseases, Children's Memorial Hospital, Chicago, Illinois

☆☆

Reprint requests: Elaine A. Rosenfeld, MD, Children's Memorial Hospital, Division of Infectious Diseases, 2300 Children's Plaza, Box No. 20, Chicago, IL 60614.

0022-3476/95/$3.00 + 0 9/20/61437

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