Acute Phase Treatment for Infants Younger Than 1 Year of Age with Kawasaki Disease: A Single Center Retrospective Study
Abstract
Background: Infants younger than 1 year of age with Kawasaki disease (KD) have a high risk for coronary artery lesions (CAL). However, the appropriate acute phase treatment for the infants has not been established.
Objective: To ascertain the usefulness of an initial single intravenous immunoglobulin (IVIG) therapy (2g/ kg) with delayed use of aspirin (DUA) for the infants.
Materials and Methods: The outcomes in 205 patients who underwent initial single IVIG therapy at 2g/ kg/ dose with DUA for KD were investigated retrospectively. These subjects were divided into those aged <1 year (infant group, n = 43) and those aged 1 year or older (non-infant group, n=162). Statistical analyses were performed using Stat Flex Version 6 for Windows. Chi-square, Fisher’s exact, and Mann-Whitney U tests were used as appropriate, with sample size considerations.
Results: Numbers of major signs in infant group were significantly fewer than those in non-infant group (median 5, interquartile range [IQ]: 5-5 vs. 6, IQ: 5-6, P <0.001). The prevalence of incomplete type (20.9% vs. 11.1%, P=0.091), timing of initial IVIG therapy in regards to day of illness onset (median 5, IQ: 5-6 vs. 5, IQ: 5-6, P=0.452), the prevalence of rescue therapies (9.3% vs. 13.6%, P=0.454), and CAL (0.0% vs. 3.1%, P=0.368) were similar between the 2 groups. No infants received steroids and had the CAL 3mm. The prevalence of initial IVIG therapy resistant patients in infant group was significantly lower than that in non-infant group (9.3% vs. 26.5%, P = 0.017). The defervescence days of illness in infant group were significantly earlier than those in non-infant group (median 6, IQ: 6-7 vs. 7, IQ: 6-8, P <0.001).
Conclusion: The infants who are treated appropriately may not have a chance to higher risk of large CAL. An initial single IVIG therapy (2 g/kg) with DUA was useful for prevention of CAL 3 mm in infants with KD.
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