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Original article
Coronary artery aneurysms are more severe in infants than in older children with Kawasaki disease
  1. Scott A Cameron1,
  2. Michael Carr1,
  3. Elfriede Pahl1,
  4. Nicole DeMarais2,
  5. Stanford T Shulman3,
  6. Anne H Rowley3
  1. 1 Division of Cardiology, Ann & Robert H Lurie Children’s Hospital of Chicago, Chicago, Illinois, USA
  2. 2 Chicago Medical School, North Chicago, Illinois, USA
  3. 3 Division of Infectious Diseases, Ann & Robert H Lurie Children’s Hospital of Chicago, Chicago, Illinois, USA
  1. Correspondence to Dr Anne H Rowley, Division of Infectious Diseases, Ann & Robert H Lurie Children’s Hospital of Chicago, Chicago, IL 60611, USA; arowley{at}luriechildrens.org

Abstract

Objective We aimed to compare the severity of coronary artery abnormalities in Kawasaki disease between infants and older children.

Methods We retrospectively reviewed and compared coronary artery dilation and aneurysm severity in infants <1 year of age with Kawasaki disease at our centre over a 10-year period with that observed in children ≥1 year of age in the Pediatric Heart Network Trial of Pulse Steroid Therapy in Kawasaki Disease. Coronary artery abnormalities were defined by z-scores according to American Heart Association guidelines.

Results Of the 93 infants identified during the study period, 80 were treated with intravenous gamma globulin within the first 10 days of illness and were included for comparison to 170 children ≥1 year of age treated in the same time frame from the Pediatric Heart Network public database. The mean maximum z-score was significantly higher in infants compared with older children (3.37 vs 2.07, p<0.001). A higher incidence of medium and giant aneurysms was observed in infants compared with children ≥1 year of age (11% vs 3% for medium aneurysms, p=0.015; 8% vs <1% for giant aneurysms, p=0.005).

Conclusions Infants with Kawasaki disease have more severe coronary artery dilation compared with older children, and a higher prevalence of medium and giant aneurysms. Because adverse outcomes are closely linked to the maximal coronary artery diameter in Kawasaki disease, patients diagnosed as infants require very close long-term monitoring for cardiac complications.

  • cardiology
  • infectious diseases
  • vascular disease

https://doi.org/10.1136/archdischild-2018-314967

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    Footnotes

    • Contributors AHR conceptualised the study, drafted the initial manuscript, and reviewed and revised the manuscript. MC, EP and STS aided in conceptualisation, and reviewed and revised the manuscript. SAC aided in conceptualisation, designed the study, drafted the initial manuscript, designed the data collection instruments, collected data, carried out the statistical analyses, and reviewed and revised the manuscript. ND aided in data collection and manuscript review and editing. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

    • Funding This study was supported by NIAMS R21AR068041, NCATS UL1TR001422, Max Goldenberg Foundation, and the Center for Kawasaki Disease at the Ann & Robert H Lurie Children’s Hospital of Chicago.

    • Disclaimer The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

    • Competing interests None declared.

    • Patient consent Not required.

    • Ethics approval Institutional Review Board of Ann & Robert H Luire Children’s Hospital of Chicago.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement The Pediatric Heart Network data used in this study are from a public database that is freely available on the internet at: http://www.pediatricheartnetwork.org/ForResearchers/PHNPublicUseDatasets.aspx

    • Collaborators David Russell.