Carlos D Grasa1, Elisa Fernández-Cooke2,3,4, Judith Sánchez-Manubens5, Begoña Carazo-Gallego6, Javier Aracil-Santos7, Jordi Anton5, María José Lirola8, Beatriz Mercader9, Enrique Villalobos10, Matilde Bustillo11, Gemma Giralt12, Beatriz Rocandio13, Lucía M Escribano14, Sara Domínguez-Rodríguez2,3, Cristina Calvo7,4,15. 1. Department of Pediatric Infectious Diseases, Hospital Universitario La Paz, Pº Castellana, 261, 28046, Madrid, Spain. carlosgrasa@gmail.com. 2. Pediatric Research and Clinical Trial Unit (UPIC), Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital Universitario, 12 Octubre, Madrid, Spain. 3. imas2, Instituto de Investigación Sanitaria Hospital, 12 de Octubre, Madrid, Spain. 4. RITIP, Spanish Network for the Research in Pediatric Infectious Diseases, Madrid, Spain. 5. Department of Pediatric Rheumatology, Hospital Sant Joan de Deu, Barcelona, Spain. 6. Department of Pediatric Infectious Diseases, Hospital Regional Universitario, Malaga, Spain. 7. Department of Pediatric Infectious Diseases, Hospital Universitario La Paz, Pº Castellana, 261, 28046, Madrid, Spain. 8. Department of Pediatric Rheumatology, Instituto Hispalense de Pediatría, Seville, Spain. 9. Department of Pediatrics, Hospital Virgen de La Arrixaca, Murcia, Spain. 10. Department of Pediatrics, Hospital Niño Jesús, Madrid, Spain. 11. Department of Pediatric Infectious Diseases, Hospital Miguel Servet, Zaragoza, Spain. 12. Department of Pediatric Cardiology, Hospital Vall D'Hebron, Barcelona, Spain. 13. Department of Pediatrics, Hospital Universitario Donostia, San Sebastián, Spain. 14. Department of Pediatric Cardiology, Hospital General de Albacete, Albacete, Spain. 15. IdiPaz, Institute for Health Research From La Paz Hospital, Madrid, Spain.
Abstract
A retrospective study that compared children younger than 6 months versus older children of a Spanish cohort of patients diagnosed with Kawasaki disease between 2011 and 2016 (Kawa-Race study). From the 598 patients recruited, 42 patients were younger than 6 months (7%) and presented more frequently with an incomplete diagnosis of Kawasaki disease (52.4 vs 27.9%, p = 0.001). Cardiac abnormalities detected by echocardiography were more common in younger patients (52.4 vs 30%, p = 0.002). These younger patients presented with a higher proportion of coronary aneurysms as well (19 vs 8.6%, p < 0.001). Shock at diagnosis (9.5 vs 1.9%, p = 0.016) and admission to intensive care units (17.7 vs 4.1%, p = 0.003) were more frequent in patients younger than 6 months. There were no statistically significant differences in relation to infections, non-response to IVIG, or mid- or long-term outcomes. Conclusion: Data of the Spanish cohort are consistent with other American and Asian studies, although Spanish children younger than 6 months had a lower rate of non-response to IVIG and better clinical outcomes. A high index of suspicion should be considered for this population due to a higher risk of coronary abnormalities, presentation of shock, and admission to the intensive care unit. What is Known: •Children below 6 months of age with Kawasaki disease (KD) have different features compared to older. •Younger patients usually have an incomplete form of KD and coronary artery abnormalities. What is New: •Younger than 6 months with KD presented with shock and required admission to PICU more frequently compared to older. •Infections play a similar role in KD despite the age of the patients.
A retrospective study that compared children younger than 6 months versus older children of a Spanish cohort of patients diagnosed with Kawasaki disease between 2011 and 2016 (Kawa-Race study). From the 598 patients recruited, 42 patients were younger than 6 months (7%) and presented more frequently with an incomplete diagnosis of Kawasaki disease (52.4 vs 27.9%, p = 0.001). Cardiac abnormalities detected by echocardiography were more common in younger patients (52.4 vs 30%, p = 0.002). These younger patients presented with a higher proportion of coronary aneurysms as well (19 vs 8.6%, p < 0.001). Shock at diagnosis (9.5 vs 1.9%, p = 0.016) and admission to intensive care units (17.7 vs 4.1%, p = 0.003) were more frequent in patients younger than 6 months. There were no statistically significant differences in relation to infections, non-response to IVIG, or mid- or long-term outcomes. Conclusion: Data of the Spanish cohort are consistent with other American and Asian studies, although Spanish children younger than 6 months had a lower rate of non-response to IVIG and better clinical outcomes. A high index of suspicion should be considered for this population due to a higher risk of coronary abnormalities, presentation of shock, and admission to the intensive care unit. What is Known: •Children below 6 months of age with Kawasaki disease (KD) have different features compared to older. •Younger patients usually have an incomplete form of KD and coronary artery abnormalities. What is New: •Younger than 6 months with KD presented with shock and required admission to PICU more frequently compared to older. •Infections play a similar role in KD despite the age of the patients.
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