Early Therapeutic Intervention With IVIG Is Effective In Infants Less Than 3months With Kawasaki Disease

Background: Kawasaki disease (KD) in infants less than 3 months (<3M) is reported rare, but incomplete type or coronary artery lesion are more frequent than in older ages. Purpose: To elucidate the correlation between treatment effect and age in KD. Methods: A total of 367 children with KD were admitted in our hospital from 2007 to 2014. A Comparison was made among 3 age groups (<3M, 3 months to less than5 years {3M-5Y} and 5years or older {≧5Y}) from the view points of disease type (complete or incomplete depend on major symptoms are 5 or less out of 6), effect of initial intravenous immunoglobulin (IVIG) and coronary artery lesion (dilation or aneurysm formation). Results: Incomplete type of KD was seen in 82% of <3M (14/17), whereas 6.6% (20/300) in 3M-5Y and 4.0% (2/50) in ≧5Y. Initial IVIG was unsuccessful in 24% (4 cases) in <3M, 22% (66 cases) in 3M-5Y and 38% (19 cases) in≧5Y. Coronary artery lesion was observed in 5.8% (1 case) in <3M, 0.6% (2 cases) in 3M-5Y and 2% (1cases) in ≧5Y. Discussion: Since the time from the initial symptom of KD to the first visit to our department was shorter in <3m infants (1.53 days) than the older age groups (4.18 days in 3M-5Y and 4.44 days in ≧5Y), majority of <3M infants with KD showed less than 5 major symptoms; polymorphous exanthema in 88%, lip and oral cavity findins in 76%, bilateral bulbar conjunctival congestion in 59%, extremities changes in 23%, cervical lymphoadenopathy in 18%. We make a diagnosis of KD in <3M infants when labolatory data suggests vasculitis and/or echocardiography reveals abnomal findings, together with major clinical symptoms even less than 5. Based on these diagnosistic process , we started initial IVIG by 4 days and achieved satisfactory results.