PMID- 24636168 OWN - NLM STAT- MEDLINE DCOM- 20160316 LR - 20181202 IS - 2212-1692 (Electronic) IS - 1875-9572 (Linking) VI - 55 IP - 5 DP - 2014 Oct TI - Timing of intravenous immunoglobulin treatment and risk of coronary artery abnormalities in children with Kawasaki disease. PG - 387-92 LID - S1875-9572(14)00028-X [pii] LID - 10.1016/j.pedneo.2013.11.007 [doi] AB - BACKGROUND: Kawasaki disease (KD) is a type of febrile self-limiting systemic vasculitis, which affects the coronary arteries (CA) and may cause cardiac ischemia during childhood and adult life. Intravenous immunoglobulin (IVIG) has become the standard therapy for KD. However, it is still uncertain if CA outcome is associated with the timing of IVIG administration with reference to fever onset. METHODS: The present study was designed to identify the risk for development and delay in resolution of CA abnormalities in association with IVIG administration within or after 10 days of KD onset. A retrospective analysis of clinical signs, laboratory data, and prospectively collected echocardiography (ECHO) results of 106 children hospitalized with KD was utilized. RESULTS: IVIG was administered to 86 (81.1%) patients within 10 days, and 20 (18.9%) patients received the first dose of IVIG after 10 days of illness. Among 23 (21.6%) patients who were diagnosed with CA lesions, 18 had a CA abnormality at initial ECHO, whereas they appeared after IVIG therapy in five patients. The risk for CA lesions on initial ECHO was higher among the patients who were admitted after 10 days of disease onset [odds ratio (OR) = 5.3, 95% confidence interval (CI) = 1.7-15.9] but comparable with the post-IVIG treatment group (OR = 3.1, 95% CI = 0.48-19.8). The age <1 year and erythrocyte sedimentation rate (ESR) > 40 mm/hour were associated with non-resolution of CA lesions within 9 weeks of KD onset. Overall, 95.6% of children had resolution of CA abnormalities within 6 months of onset of KD symptoms. CONCLUSION: The results of this study suggest that although IVIG treatment within 10 days is important to minimize development of cardiac pathology, neither occurrence of CA lesions in IVIG-treated children nor the time frame for resolution of established CA abnormalities was associated with the timing of IVIG administration. Age <1 year and high ESR (>40 mm/hour) predict a delay in resolution of CA lesions among children with KD. CI - Copyright (c) 2014. Published by Elsevier B.V. FAU - Bal, Aswine K AU - Bal AK AD - Rutgers Robert Wood Johnson Medical School, Department of Pediatrics, 1 Robert Wood Johnson Place, New Brunswick, NJ 08903, USA; K. Hovnanian Children's Hospital, Jersey Shore University Medical Center, 1945 Corlies Avenue, Neptune, NJ 07754, USA. Electronic address: balak@rwjms.rutgers.edu. FAU - Prasad, Deepa AU - Prasad D AD - K. Hovnanian Children's Hospital, Jersey Shore University Medical Center, 1945 Corlies Avenue, Neptune, NJ 07754, USA. FAU - Umali Pamintuan, Maria Angela AU - Umali Pamintuan MA AD - K. Hovnanian Children's Hospital, Jersey Shore University Medical Center, 1945 Corlies Avenue, Neptune, NJ 07754, USA. FAU - Mammen-Prasad, Elizabeth AU - Mammen-Prasad E AD - K. Hovnanian Children's Hospital, Jersey Shore University Medical Center, 1945 Corlies Avenue, Neptune, NJ 07754, USA. FAU - Petrova, Anna AU - Petrova A AD - Rutgers Robert Wood Johnson Medical School, Department of Pediatrics, 1 Robert Wood Johnson Place, New Brunswick, NJ 08903, USA; K. Hovnanian Children's Hospital, Jersey Shore University Medical Center, 1945 Corlies Avenue, Neptune, NJ 07754, USA. LA - eng PT - Journal Article DEP - 20140311 PL - Singapore TA - Pediatr Neonatol JT - Pediatrics and neonatology JID - 101484755 RN - 0 (Immunoglobulins, Intravenous) SB - IM MH - Child, Preschool MH - Coronary Artery Disease/diagnostic imaging/*etiology MH - Coronary Vessels/diagnostic imaging MH - Drug Administration Schedule MH - Female MH - Humans MH - Immunoglobulins, Intravenous/*administration & dosage MH - Infant MH - Male MH - Mucocutaneous Lymph Node Syndrome/*complications/*drug therapy MH - Retrospective Studies MH - Risk Factors MH - Ultrasonography OTO - NOTNLM OT - IVIG treatment OT - Kawasaki disease OT - children OT - coronary abnormalities EDAT- 2014/03/19 06:00 MHDA- 2016/03/17 06:00 CRDT- 2014/03/19 06:00 PHST- 2013/05/16 00:00 [received] PHST- 2013/10/11 00:00 [revised] PHST- 2013/11/26 00:00 [accepted] PHST- 2014/03/19 06:00 [entrez] PHST- 2014/03/19 06:00 [pubmed] PHST- 2016/03/17 06:00 [medline] AID - S1875-9572(14)00028-X [pii] AID - 10.1016/j.pedneo.2013.11.007 [doi] PST - ppublish SO - Pediatr Neonatol. 2014 Oct;55(5):387-92. doi: 10.1016/j.pedneo.2013.11.007. Epub 2014 Mar 11.