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Kawasaki disease in children younger than 6 months of age: characteristics of a Spanish cohort

  • Original Article
  • Published:
European Journal of Pediatrics Aims and scope Submit manuscript

Abstract

A retrospective study that compared children younger than 6 months versus older children of a Spanish cohort of patients diagnosed with Kawasaki disease between 2011 and 2016 (Kawa-Race study). From the 598 patients recruited, 42 patients were younger than 6 months (7%) and presented more frequently with an incomplete diagnosis of Kawasaki disease (52.4 vs 27.9%, p = 0.001). Cardiac abnormalities detected by echocardiography were more common in younger patients (52.4 vs 30%, p = 0.002). These younger patients presented with a higher proportion of coronary aneurysms as well (19 vs 8.6%, p < 0.001). Shock at diagnosis (9.5 vs 1.9%, p = 0.016) and admission to intensive care units (17.7 vs 4.1%, p = 0.003) were more frequent in patients younger than 6 months. There were no statistically significant differences in relation to infections, non-response to IVIG, or mid- or long-term outcomes.

Conclusion: Data of the Spanish cohort are consistent with other American and Asian studies, although Spanish children younger than 6 months had a lower rate of non-response to IVIG and better clinical outcomes. A high index of suspicion should be considered for this population due to a higher risk of coronary abnormalities, presentation of shock, and admission to the intensive care unit.

What is Known:

•Children below 6 months of age with Kawasaki disease (KD) have different features compared to older.

•Younger patients usually have an incomplete form of KD and coronary artery abnormalities.

What is New:

•Younger than 6 months with KD presented with shock and required admission to PICU more frequently compared to older.

•Infections play a similar role in KD despite the age of the patients.

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Availability of data and materials

There are no data stored in a repository, but data could be available after approval under a reasonable request. Contact e-mail: kawasaki.kawarace@gmail.com.

Abbreviations

ASA:

Acetylsalicylic acid

CAA:

Coronary artery aneurysms

ED:

Emergency Department

iKD:

Incomplete Kawasaki disease

IVIG:

Intravenous immunoglobulin

KD:

Kawasaki disease

MCI:

Microbiological confirmed infection

PICU:

Pediatric Intensive Care Unit

RPI:

Recent previous infection

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Acknowledgements

To the patients and their families

To Sara Borrego Martín and Tamara Rodríguez Uribe, who started to work in this project as medical students

To Kinga Sandor-Bajusz for English revision

To the KAWA-RACE network and their collaborators

In memory of Tomisaku Kawasaki (1925–2020) for a life dedicated to describing and understanding this rare disease and taking care of so many patients with Kawasaki disease

The KAWA-RACE study group is composed by:

Study coordinator: Elisa Fernández-Cooke (Hospital Doce de Octubre, Spain). Scientific committee: Elisa Fernandez-Cooke (Hospital 12 de Octubre, Madrid), Cristina Calvo (Hospital Universitario La Paz, Madrid), Ana Barrios Tascón (Hospital Universitario Infanta Sofía, Madrid), Judith Sánchez-Manubens (Hospital Sant Joan de Deu, Barcelona), Jordi Antón (Hospital Sant Joan de Deu, Barcelona), Javier Aracil Santos (Hospital Universitario La Paz, Madrid), Esmeralda Núñez Cuadros (Hospital Regional Universitario de Málaga), María Luisa Navarro Gómez (Hospital Universitario Gregorio Marañón, Madrid), David Moreno Pérez (Hospital Regional Universitario de Málaga).

Collaborating members:

María Martín Cantero Pérez (Hospital Regional Universitario de Málaga), Esmeralda Nuñez Cuadros Pérez (Hospital Regional Universitario de Málaga), Begoña Carazo Gallego Pérez (Hospital Regional Universitario de Málaga), Fernando Sánchez García (Hospital La Inmaculada, Almería), Marisol Camacho Lovillo (Hospital Virgen del Rocío, Sevilla), Renata Marqués (Hospital Virgen del Rocío, Sevilla), Olaf Neth (Hospital Virgen del Rocío, Sevilla), Laura, Fernández Silveira (Hospital Virgen del Rocío, Sevilla), Miguel Sánchez Forte (Hospital Torrecárdenas, Almería), Ángeles Ortega Montes (Hospital Torrecárdenas, Almería), Leticia Isabel Martínez Campos (Hospital Torrecárdenas, Almería), Beatriz Bravo Mancheño (Hospital Universitario Virgen de las Nieves, Granada), Margarita Camacho (Hospital Universitario Virgen de las Nieves, Granada), Antonio F Medina Claros (Hospital de la Axarquía, Murcia), Carlos Salido (Hospital de Jerez), María Torres Rico (Hospital Juan Ramón Jiménez de Huelva), Beatriz Ruiz Saez (Hospital Reina Sofía de Córdoba), Elena Fernández de la Puebla Lechuga (Hospital Reina Sofía de Córdoba), Mª José Lirola Cruz (Instituto Hispalense de pediatría, Sevilla), Kety Maya Carrasco (Instituto Hispalense de pediatría, Sevilla), Moisés Rodríguez González (Hospital Universitario Puerta Del Mar de Cádiz), Enrique Blanca Jover (Complejo Hospitalario Granada), José Uberos Fernández (Complejo Hospitalario Granada), María Mercedes Ibáñez Alcalde (Hospital de Poniente, Almería), Pilar Collado (Hospital Universitario Miguel Servet, Zaragoza), Carmelo Guerrero Laleona (Hospital Universitario Miguel Servet, Zaragoza), Lorenzo Jiménez Montañés (Hospital Universitario Miguel Servet, Zaragoza), Ariadna Ayerza Casas (Hospital Clínico Universitario Lozano Blesa, Zaragoza), Bárbara Montes Zapico (Hospital San Agustín, Avilés), Carlos Pérez Méndez (Hospital Universitario de Cabueñes, Gijón), Javier Fernández Aracama (Hospital Universitario Basurto, Bilbao), Lucía Rodríguez (Hospital Central de Asturias, Oviedo), María Aleida Ibáñez Fernández (Hospital Central de Asturias, Oviedo), Sandra Navarro Campo (Hospital Central de Asturias, Oviedo), Silvia Escribà Bori (Hospital Universitario Son Espases, Palma de Mallorca), María Concepción Mir Perelló (Hospital Universitario Son Espases, Palma de Mallorca), Mª Ángeles de la Fuente Sánchez (Hospital Universitario Son Espases, Palma de Mallorca), Patricia Aparicio García (Hospital Son Llátzer, Palma de Mallorca), Carlos Briales (Hospital Son Llátzer, Palma de Mallorca), Joaquín Castilla Crespí (Hospital Son Llátzer, Palma de Mallorca), María Elena Colino Gil (Hospital Materno-Infantil de Las Palmas de Gran Canaria), Nerea Delgado Cabrera (Hospital Materno-Infantil de Las Palmas de Gran Canaria), Ana Bello Naranjo (Hospital Materno-Infantil de Las Palmas de Gran Canaria), Jesús Poch Páez (Hospital Materno-Infantil de Las Palmas de Gran Canaria), Moneyba García Yáñez (Hospital Materno-Infantil de Las Palmas de Gran Canaria), Montse González García (Hospital Universitario Nuestra señora de Candelaria de Santa Cruz de Tenerife), Maite Viadero (Hospital Universitario Marqués de Valdecilla, Santander), Beatriz Jiménez Montero (Hospital Universitario Marqués de Valdecilla, Santander), Olga Domínguez García (Hospital Virgen de la Salud de Toledo), Begoña Losada Pinedo (Hospital Virgen de la Salud de Toledo), Gema Iñigo Martín (Hospital Virgen de la Salud de Toledo), Lucía María Escribano Gómez (Hospital General de Albacete), Antonio Cepillo (Hospital General de Albacete), Miguel Lillo Lillo (Hospital General de Albacete), María Isabel Buedo (Hospital General de Albacete), Laura del Rey (Hospital General de Albacete), Elena Urbaneja Rodríguez (Hospital Clínico Universitario de Valladolid), Sara Rellán Rodríguez (Hospital Clínico Universitario de Valladolid), Teresa Cantero (Hospital de Palencia), Beatriz Plata Izquierdo (Complejo Asistencial Universitario de Salamanca), Luisa García-Cuenllas Álvarez (Complejo Asistencial Universitario de Salamanca), Ignacio Oulego Erroz (Hospital de León), Elena Pérez Santaolalla (Hospital Universitario de Burgos), Carlos Alcalde Martín (Hospital Universitario Río Hortega de Valladolid), Fernando Centeno Malfaz (Hospital Universitario Río Hortega de Valladolid), Elena Pérez Gutiérrez (Hospital Universitario Río Hortega de Valladolid), Mª Soledad Jiménez Casso (Hospital General de Segovia), Fredy Prada (Hospital Sant Joan de Déu, Barcelona), Rosa Bou (Hospital Sant Joan de Déu, Barcelona), Estibaliz Iglesias (Hospital Sant Joan de Déu, Barcelona), Joan Calzada (Hospital Sant Joan de Déu, Barcelona), Olga Calavia Garsaball (Hospital Joan XXIII de Tarragona), Marc Tobeña Rue (Hospital Vall d’Hebron, Barcelona), Gemma Giralt García (Hospital Vall d’Hebron, Barcelona), Silvia Yevenes Ruiz (Hospital Vall d’Hebron, Barcelona), Zulema Lobato (Xarxa Assistencial i Universitaria de Manresa), Neus Rius Gordillo (Hospital Sant Joan de Reus), Montserrat Pascual Torres (Hospital Sant Joan de Reus), María Méndez Hernández (Hospital Germans Trias i Pujol de Badalona), Lourdes García (Hospital de Mataró), Sergio Flores Villar (Hospital Universitari Mútua de Terrassa), Laura Minguell Domingo (Hospital Arnau de Vilanova, Lleida), Anna Ballester (Hospital de Calella), Ana Miralles (Hospital de Palamós), Berta Pujol Soler (Hospital General de Granollers), Anton Foguet Vidal (F. Hospital d’Olot Comarcal de la Garrotxa), Pere Sala Castellví (Hospital de Barcelona), Angelita Serrano Aguiar (Hospital Comarcal Mòra d'Ebre), José Manuel Siurana Rodríguez (Hospital HM Nens. HM Hospitales), Anna Sangorrin Iranzo (Hospital HM Nens. HM Hospitales), Roser Álvarez Pérez (Hospital de la Santa Creu i Sant Pau de Barcelona), Paula Ribes Cajas (Hospital General de Catalunya), Pere Genaró i Jornet (Hospital Verge de la Cinta, Tortosa), Ana Grande Tejada (Complejo Hospitalario Universitario Infanta Cristina, Badajoz), Cristina Zarallo (Complejo Hospitalario Universitario Infanta Cristina, Badajoz), Federico Martinón-Torres (Hospital Clínico Universitario de Santiago de Compostela), Irene Rivero Calle (Hospital Clínico Universitario de Santiago de Compostela), Antonio Justicia Grande, (Hospital Clínico Universitario de Santiago de Compostela), María López Sousa (Hospital Clínico Universitario de Santiago de Compostela), Alejandro Souto Vilas (Hospital Clínico Universitario de Santiago de Compostela), Bernardo López Abel (Hospital Clínico Universitario de Santiago de Compostela), Elisa de Miguel Esteban (Hospital San Pedro, Logroño), Bibiana Riaño Méndez (Hospital San Pedro, Logroño), Daniel Blázquez (Hospital Universitario Doce de Octubre, Madrid), Pablo Rojo Conejo (Hospital Universitario Doce de Octubre, Madrid), Carlos Grasa Lozano (Hospital Universitario La Paz, Madrid), Belén Toral (Hospital Universitario Doce de Octubre, Madrid), Leticia Albert De la Torre (Hospital Universitario Doce de Octubre, Madrid), Jaime de Inocencio (Hospital Universitario Doce de Octubre, Madrid), Mar Santos (Hospital Universitario Gregorio Marañón, Madrid), Rafael Díaz-Delgado de la Peña (Hospital Severo Ochoa, Leganés), Paz Collado Ramos (Hospital Severo Ochoa, Leganés), Alfredo Tagarro (Hospital Universitario Infanta Sofía, Madrid), Teresa Raga (Hospital Universitario Infanta Sofía, Madrid), Libertad Latorre (Hospital Universitario Infanta Sofía, Madrid), Sara Guillén (Hospital de Getafe), Ignacio Callejas Caballero (Hospital de Getafe), Luis Manuel Prieto Tato (Hospital 12 de Octubre), María Fernanda Guzmán Monagas (HM Hospitales Madrid), Isabel Jiménez López (HM Hospitales Madrid), Sandra Villagrá (HM Hospitales Madrid), Viviana Arreo (HM Hospitales Madrid), Roi Piñeiro Pérez (Hospital General de Vilalba), María de la Parte (Hospital General de Villalba), Amalia Tamariz-Martes (Hospital Infantil Universitario Niño Jesús, Madrid), Marta Llorente Romano (Hospital del Sureste, Madrid), Maria Belén Hernández Rupérez (Hospital del Sureste, Madrid), Sonia Rodríguez Martin (Hospital Universitario Príncipe de Asturias, Alcalá de Henares), Henar Rojo Sombrero (Hospital Universitario Príncipe de Asturias, Alcalá de Henares), Estefanía García Cerro (Hospital Universitario Príncipe de Asturias, Alcalá de Henares), Irene Maté Cano (Hospital del Henares, Coslada), Marta Villares Alonso (Hospital de Móstoles), Marta Pilar Osuna Marco (Hospital de Móstoles), Julia Jensen Veron (Hospital Infanta Cristina, Madrid), Cristina Zarallo Reales (Hospital Infanta Cristina, Madrid), María Dolores Rodríguez Mesa (Hospital Infanta Cristina, Madrid), Santiago Rueda Esteban (Hospital Clínico San Carlos, Madrid), José Tomás Ramos Amador (Hospital Clínico San Carlos, Madrid), Cristina González Menchén (Hospital Clínico San Carlos, Madrid), Ana Belén Jiménez Jiménez (Hospital Universitario Fundación Jiménez Díaz, Madrid), Pilar Galán (Hospital Universitario de Fuenlabrada), Dolores Pérez Campos (Hospital Universitario de Fuenlabrada), Mª Mercedes Bueno (Fundación Hospital de Alcorcón), David Crespo Marcos (Fundación Hospital de Alcorcón), Enrique Otheo de Tejada Barásoain (Hospital Ramón y Cajal, Madrid), Walter Alberto Sifuentes Giraldo (Hospital Ramón y Cajal, Madrid), María Luz Gámir Gámir (Hospital Ramón y Cajal, Madrid), María José Cilleruelo Ortega (Hospital Puerta de Hierro, Majadahonda), Agustín López López (Hospital Puerta de Hierro, Majadahonda), Cristina Sánchez Vaquerizo (Hospital Puerta de Hierro, Majadahonda), Ana Isabel Usano Carrasco (Hospital Puerta de Hierro, Majadahonda), Ester Moreno Gómez (Hospital San Rafael, Madrid), Jaime Carrasco Colom (Hospital Sanitas La Moraleja, Madrid), Olga Carvajal del Castillo (Hospital Rey Juan Carlos, Móstoles), Beatriz Del Pozo Menéndez Hospital de Torrejón), Katie Badillo Navarro (Hospital de Torrejón), Fernando Baquero (Hospital Universitario La Paz, Madrid), Lucía Deiros Bronte (Hospital Universitario La Paz, Madrid), Pablo Fernández Fraga (Hospital Universitario La Paz, Madrid), Nieves Domínguez (Hospital Universitario Infanta Elena, Madrid), Francisco Castro García (Hospital Clínico Universitario Virgen de la Arrixaca, Murcia), Elena Vera Romero (Hospital Clínico Universitario Virgen de la Arrixaca, Murcia), Águeda Herrera Chamorro (Hospital Clínico Universitario Virgen de la Arrixaca, Murcia), Paula Alcañiz Rodríguez (Hospital Clínico Universitario Virgen de la Arrixaca, Murcia), Moisés Sorlí García (Hospital Clínico Universitario Virgen de la Arrixaca, Murcia), María Concepción Rex Nicolás (Hospital Universitario Santa Lucía, Cartagena), Ana Lorente Nicolás (Hospital Universitario Santa Lucía, Cartagena), Patricia Martínez Olorón (Complejo Hospitalario de Navarra), Beatriz Rocandio Cilveti (Hospital de Donostia), Amaia Berridi (Hospital de Donostia), Laura Santos-Díez Vázquez (Hospital de Cruces, Bilbao), Olaia Fernández (Hospital Universitario Basurto, Bilbao), Inmaculada Calvo (Hospital Universitario y Politécnico La Fe, Valencia), Belén Fernández Tudela (Hospital Universitario y Politécnico La Fe, Valencia), Manuel Oltra Benavent (Hospital Universitario y Politécnico La Fe, Valencia), Marta Dapena Archilés (Hospital General de Castellón), Franciasco Sanchez Ferrer (Hospital Universitario de San Juan de Alicante), César Gavilán (Hospital Universitario de San Juan de Alicante), Ignacio Izquierdo Fos (Hospital Universitario de Elche), María Isabel Serrano Robles (Hospital Universitario de Elche), Yolanda Herranz Sánchez (Hospital Marina Baixa de Alicante), Enrique Villalobos Pinto (Hospital Infantil Universitario Niño Jesús, Madrid), Daniel Clemente Garulo (Hospital Infantil Universitario Niño Jesús, Madrid), Beatriz Mercader Rodríguez (Hospital Clínico Universitario Virgen de la Arrixaca, Murcia), Matilde Bustillo Alonso (Hospital Universitario Miguel Servet, Zaragoza)

Funding

KAWA-RACE receipt an award by the Spanish Society of Pediatric Rheumatology (SERPE). CDG is funded by the Spanish Ministry of Science and Innovation—Instituto de Salud Carlos III and Fondos FEDER (Contrato Río Hortega CM19/00015).

Author information

Authors and Affiliations

  1. Department of Pediatric Infectious Diseases, Hospital Universitario La Paz, Pº Castellana, 261, 28046, Madrid, Spain

    Carlos D. Grasa, Javier Aracil-Santos & Cristina Calvo

  2. Pediatric Research and Clinical Trial Unit (UPIC), Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital Universitario, 12 Octubre, Madrid, Spain

    Elisa Fernández-Cooke & Sara Domínguez-Rodríguez

  3. imas2, Instituto de Investigación Sanitaria Hospital, 12 de Octubre, Madrid, Spain

    Elisa Fernández-Cooke & Sara Domínguez-Rodríguez

  4. RITIP, Spanish Network for the Research in Pediatric Infectious Diseases, Madrid, Spain

    Elisa Fernández-Cooke & Cristina Calvo

  5. Department of Pediatric Rheumatology, Hospital Sant Joan de Deu, Barcelona, Spain

    Judith Sánchez-Manubens & Jordi Anton

  6. Department of Pediatric Infectious Diseases, Hospital Regional Universitario, Malaga, Spain

    Begoña Carazo-Gallego

  7. Department of Pediatric Rheumatology, Instituto Hispalense de Pediatría, Seville, Spain

    María José Lirola

  8. Department of Pediatrics, Hospital Virgen de La Arrixaca, Murcia, Spain

    Beatriz Mercader

  9. Department of Pediatrics, Hospital Niño Jesús, Madrid, Spain

    Enrique Villalobos

  10. Department of Pediatric Infectious Diseases, Hospital Miguel Servet, Zaragoza, Spain

    Matilde Bustillo

  11. Department of Pediatric Cardiology, Hospital Vall D’Hebron, Barcelona, Spain

    Gemma Giralt

  12. Department of Pediatrics, Hospital Universitario Donostia, San Sebastián, Spain

    Beatriz Rocandio

  13. Department of Pediatric Cardiology, Hospital General de Albacete, Albacete, Spain

    Lucía M. Escribano

  14. IdiPaz, Institute for Health Research From La Paz Hospital, Madrid, Spain

    Cristina Calvo

Authors
  1. Carlos D. Grasa
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  2. Elisa Fernández-Cooke
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  3. Judith Sánchez-Manubens
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  4. Begoña Carazo-Gallego
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  5. Javier Aracil-Santos
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  6. Jordi Anton
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  7. María José Lirola
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  8. Beatriz Mercader
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  9. Enrique Villalobos
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  10. Matilde Bustillo
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  11. Gemma Giralt
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  12. Beatriz Rocandio
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  13. Lucía M. Escribano
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  14. Sara Domínguez-Rodríguez
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  15. Cristina Calvo
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Contributions

All authors contributed to the study concept and design. Carlos Daniel Grasa wrote the first draft of the manuscript and all authors commented on the previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Carlos D. Grasa.

Ethics declarations

Ethics approval

Ethical approval was obtained by Ethics and Research Committee from Principal Investigator Hospital (Hospital Universitario 12 de Octubre, code 15/316, dated 28th October 2015) and from the other collaborator hospitals.

Consent to participate

Consent was waived due to the retrospective analysis and the deidentification of the database.

Consent for publication

Consent form from patients or parents/guardians was not obtained because it was a retrospective study.

Conflict of interest

The authors declare no competing interests.

Additional information

Communicated by Nicole Ritz

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Cite this article

Grasa, C.D., Fernández-Cooke, E., Sánchez-Manubens, J. et al. Kawasaki disease in children younger than 6 months of age: characteristics of a Spanish cohort. Eur J Pediatr 181, 589–598 (2022). https://doi.org/10.1007/s00431-021-04215-8

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  • DOI: https://doi.org/10.1007/s00431-021-04215-8

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