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Kawasaki disease in infants less than one year of age
E A Rosenfeld1, K E Corydon, S T Shulman
1Department of Pediatrics, Northwestern University Medical School, Children's Memorial Hospital, Chicago, IL 60614, USA.
Insights
Infants under 6 months with Kawasaki disease face a higher risk of coronary artery aneurysms (CAA). Early treatment with intravenous immune globulin (IVGG) by day 10 significantly reduces CAA development in this vulnerable population.
Area of Science:
- Pediatrics
- Cardiology
- Immunology
Background:
- Kawasaki disease (KD) is a leading cause of acquired heart disease in children.
- Infants under 12 months represent a unique, high-risk subgroup with KD.
- Severe sequelae, including coronary artery aneurysms (CAA), are a major concern in young KD patients.
Purpose of the Study:
- To identify risk factors for severe sequelae in infants with KD.
- To analyze disease characteristics in infants under 12 months.
- To assess the efficacy of intravenous immune globulin (IVGG) therapy in this population.
Main Methods:
- Retrospective chart review of children under 12 months diagnosed with KD between 1980 and 1993.
- Analysis of patient demographics, clinical features, laboratory data, and treatment outcomes.
- Comparison of CAA development based on age at onset and timing of IVGG administration.
Main Results:
- Infants under 6 months had a significantly higher incidence of giant CAA (37%) compared to those aged 6-12 months (5%).
- Treatment with IVGG by day 10 of illness was associated with a reduced frequency of CAA (29% vs. 73%) and giant CAA (4% vs. 21%) compared to later or no treatment.
- Persistent CAA rates were lower in patients treated with IVGG by day 10 (17%) versus those treated later or not at all (48%).
Conclusions:
- Infants under 6 months with Kawasaki disease are at a particularly increased risk for developing coronary artery aneurysms, including giant aneurysms.
- Early administration of IVGG therapy by day 10 of illness is crucial for mitigating the risk of CAA and giant CAA in this high-risk infant population.
- Timely IVGG intervention significantly improves outcomes, reducing the long-term cardiovascular complications associated with Kawasaki disease in infants.
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.