Tochigi, Japan

Author Affiliations: Department of Pediatrics, Jichi Medical University, Tochigi, 329-0498, Japan (Shiraishi H, Iino M, Hoshina M, Ichihashi K, Momoi MY)

Corresponding Author: Hirohiko Shiraishi, MD, Department of Pediatrics, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan (Tel: +81-285-58-7366; Fax: +81-285-44-6123; Email: shiraish@jichi.ac.jp)

Background: Coronary artery lesion (CAL) in Kawasaki disease (KD) is prevented by intravenous immunoglobulin (IVIG); however, the total amount of IVIG should be reduced if the outcome is the same. Our aim was to determine whether the treatment with IVIG at an initial dose of 1 g/kg on the 5th  to 7th day of illness with additional IVIG for refractory patients is effective for preventing CAL.

Methods: A total of 107 KD patients were treated according to the days of illness and the Harada score within 7 days of illness. All the patients with Harada score 4 or more were treated with IVIG at an initial dose of 1 g/kg, and the patients who were refractory to the initial dose, additional IVIG at a dose of 1 g/kg up to 3 g/kg was infused. Echocardiography was performed to detect the incidence of CAL.

Results: Seventy-eight patients (73%) were treated with IVIG at an initial dose of 1 g/kg according to the Harada score and the duration of illness; IVIG was started when their Harada score became 4 or more and basically on the 5th day or later. Six critically ill patients were treated with IVIG at a dose of 1 g/kg starting from the 2nd or 4th day, and all of them were refractory to the initial dose of 1 g/kg and further treated with additional doses of 1 to 3 g/kg (CAL was not observed); whereas the other 72 patients (of whom 42 were admitted by the 4th day and waited until the 5th day) were treated on the 5th to 7th day with IVIG at an initial dose of 1 g/kg. Of the 78 patients, 57 responded to the initial dose of 1 g/kg, but the remaining 21 refractory patients required additional IVIG (a total dose of IVIG up to 4 g/kg). Twenty-nine patients (27%) were treated without IVIG because their Harada score was less than 4, and CAL was not observed. In 4 (3.7%) of the 107 patients who had IVIG at 1 g/kg (n=1) or additional IVIG up to 3 g/kg (n=3), CAL appeared but regressed within 6 months after the onset.

Conclusion: Treatment of KD with IVIG at an initial dose of 1 g/kg on the 5th to 7th day with additional IVIG for refractory patients can have the same effect as the standard protocol (IVIG of 2 g/kg).

Key words: coronary artery; echocardiography; immunoglobulin; Kawasaki disease

World J Pediatr 2007;3(3):195-199