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Multicenter Study
. 2017 Jun:185:112-116.e1.
doi: 10.1016/j.jpeds.2017.03.025. Epub 2017 Apr 10.

High Risk of Coronary Artery Aneurysms in Infants Younger than 6 Months of Age with Kawasaki Disease

Andrea P Salgado  1 , Negar Ashouri  2 , Erika K Berry  1 , Xiaoying Sun  3 , Sonia Jain  3 , Jane C Burns  4 , Adriana H Tremoulet  5
Affiliations
Multicenter Study

High Risk of Coronary Artery Aneurysms in Infants Younger than 6 Months of Age with Kawasaki Disease

Andrea P Salgado et al. J Pediatr. 2017 Jun.

Abstract

Objectives: To characterize the clinical presentation and outcome in infants <6 months of age with Kawasaki disease (KD) and to describe the use of newer anti-inflammatory therapies in this young population.

Study design: We evaluated 88 infants?<6 months old and 632??6 months old treated for KD. We compared differences in laboratory data, response to treatment, and coronary artery outcomes between the 2 cohorts. Fisher exact test was used to analyze categorical variables, whereas the Wilcoxon rank sum test was used for continuous variables.

Results: The majority of children in both cohorts were diagnosed and treated within the first 10 days of illness (median illness day 6 in both cohorts). For patients treated within the first 10 days after fever onset, a larger proportion of infants <6 months old had a dilated or aneurysmal coronary artery on the initial echocardiogram compared with those ?6 months old (43.4% vs 19.5%). Furthermore, 18.6% of infants?<6 months old who had a normal echocardiogram at diagnosis, developed a dilated or aneurysmal coronary artery on a subsequent echocardiogram within 8 weeks of diagnosis. Twenty-eight infants?<6 months old received a single dose of infliximab without any untoward effects.

Conclusions: Despite treatment in the first 10 days, infants?<6 months old with acute KD are more likely to develop coronary artery abnormalities. Thus, the development of adjunctive therapies to reduce coronary artery damage should target this population.

Keywords: Kawasaki disease; coronary artery aneurysm; delayed diagnosis; infants.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1. Treatments administered to infants < 6 months old
Figure 2
Figure 2. Progression of coronary artery Z-scores of patients with KD < 6 months old by illness day at diagnosis
See this image and copyright information in PMC

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