Coronary artery aneurysms are more severe in infants than in older children with Kawasaki disease

Scott A. Cameron, Michael Richard Carr, Elfriede Pahl, Nicole Demarais, Stanford T Shulman, Anne H Rowley*

*Corresponding author for this work

Research output: Contribution to journalArticle

1 Citation (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)451-455
Number of pages5
JournalArchives of disease in childhood
Volume104
Issue number5
DOIs
StatePublished - May 1 2019

Fingerprint

Coronary Aneurysm
Mucocutaneous Lymph Node Syndrome
Coronary Vessels
Aneurysm
Dilatation
Pediatrics
Sick Leave
gamma-Globulins
Steroids
Databases
Guidelines
Incidence

Keywords

  • cardiology
  • infectious diseases
  • vascular disease

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

@article{3f55b881423144c99549c55925782470,
title = "Coronary artery aneurysms are more severe in infants than in older children with Kawasaki disease",
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.",
keywords = "cardiology, infectious diseases, vascular disease",
author = "Cameron, {Scott A.} and Carr, {Michael Richard} and Elfriede Pahl and Nicole Demarais and Shulman, {Stanford T} and Rowley, {Anne H}",
year = "2019",
month = "5",
day = "1",
doi = "10.1136/archdischild-2018-314967",
language = "English (US)",
volume = "104",
pages = "451--455",
journal = "Archives of Disease in Childhood",
issn = "0003-9888",
publisher = "BMJ Publishing Group",
number = "5",

}

Coronary artery aneurysms are more severe in infants than in older children with Kawasaki disease. / Cameron, Scott A.; Carr, Michael Richard; Pahl, Elfriede; Demarais, Nicole; Shulman, Stanford T; Rowley, Anne H.

In: Archives of disease in childhood, Vol. 104, No. 5, 01.05.2019, p. 451-455.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Coronary artery aneurysms are more severe in infants than in older children with Kawasaki disease

AU - Cameron, Scott A.

AU - Carr, Michael Richard

AU - Pahl, Elfriede

AU - Demarais, Nicole

AU - Shulman, Stanford T

AU - Rowley, Anne H

PY - 2019/5/1

Y1 - 2019/5/1

N2 - 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.

AB - 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.

KW - cardiology

KW - infectious diseases

KW - vascular disease

UR - http://www.scopus.com/inward/record.url?scp=85056421979&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85056421979&partnerID=8YFLogxK

U2 - 10.1136/archdischild-2018-314967

DO - 10.1136/archdischild-2018-314967

M3 - Article

C2 - 30413485

AN - SCOPUS:85056421979

VL - 104

SP - 451

EP - 455

JO - Archives of Disease in Childhood

JF - Archives of Disease in Childhood

SN - 0003-9888

IS - 5

ER -