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Clinical manifestations vary with different age spectrums in infants with Kawasaki disease
Hao-Chuan Liu1, Chiao-Wei Lo, Betau Hwang
1Department of Pediatrics, Taipei Veterans General Hospital Yuanshan Branch, Yilan 264, Taiwan.
Insights
Infants under six months with Kawasaki disease (KD) often present with incomplete symptoms but have a higher risk of coronary artery abnormalities (CAA). Early diagnosis and monitoring are crucial for managing this serious pediatric vasculitis.
Area of Science:
- Pediatrics
- Rheumatology
- Cardiology
Background:
- Kawasaki disease (KD) is an acute, systemic vasculitis of unknown cause.
- Diagnosis relies on clinical signs, with coronary artery abnormalities (CAA) affecting 11.0% and leading to severe cardiac complications.
- Coronary artery abnormalities (CAA) are the most serious cardiac sequelae in Kawasaki disease (KD).
Purpose of the Study:
- To investigate the clinical and laboratory differences in Kawasaki disease (KD) across various pediatric age groups.
- To identify age-specific risk factors and presentations associated with coronary artery abnormalities (CAA) in KD patients.
Main Methods:
- Children diagnosed with Kawasaki disease (KD) were stratified into three age groups: ≤6 months, 7 months to 1 year, and >1 year.
- Key clinical parameters and laboratory findings were compared across these age cohorts.
Main Results:
- Infants ≤6 months were less likely to meet KD diagnostic criteria early and had lower cholesterol levels, but showed a higher incidence of CAA.
- This youngest group also exhibited laboratory markers linked to CAA, including longer time to diagnosis confirmation, lower hemoglobin and albumin, and higher platelet counts.
- Infants under 1 year had increased leukocytosis and sterile pyuria, with a notable decrease in neck lymphadenopathy.
Conclusions:
- Younger infants (≤6 months) with Kawasaki disease (KD) present unique challenges for timely diagnosis and are at higher risk for developing coronary artery abnormalities (CAA).
- Age-specific clinical and laboratory features in KD necessitate tailored diagnostic and management approaches, particularly for infants.
- Understanding these age-related differences is vital for mitigating the long-term cardiac risks associated with Kawasaki disease (KD).
Background:
Kawasaki disease (KD) is an acute systemic vasculitis with unknown etiology. The diagnosis of KD depends on clinical manifestations. The prevalence of coronary artery abnormality (CAA) is 11.0% and results in cardiac sequelae, such as myocardial infarction or coronary aneurysm, which are the most serious complications in KD.
Methods:
We divided KD's children into different age groups: ≤6 months old, 7 months to 1 year old, and >1 year old, respectively. Different parameters were compared in each group.
Results:
Infants ≤6 months old are less likely to fulfill KD's major diagnostic criteria within 10 days, are prone to develop incomplete KD with the lowest cholesterol level, and have the greatest chance to have CAA and the laboratory features associated with CAA, such as the longest time needed to confirm CA diagnosis, lower hemoglobin level, lower albumin level, and higher platelet count. Infants <1 year old develop higher percentage of leukocytosis and sterile pyuria. But this group has fewer patients with neck lymphadenopathy.
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