Risk factors and retreatment of IVIG nonresponsiveness

Objective:To evaluate the risk factors of children with refractory Kawasaki disease(KD)and report the outcome of retreatment.Methods:Clinical data of all children with KD in Nanjing Children's Hospital were summarized from 2005 through 2009.Refractory KD was defined as those who remained febrile with a temperature beyond 38℃,48 hours after initial intravenous immunoglobulin treatment(IVIG).Results:A totle of 281 patients were included as study subjects.They received initial IVIG therapy in acute phase,and 12 did not respond to the initial IVIG therapy with an incidence of 4.27%(12/281).We found that ESR,WBC,percentage of neutrophil were risk factors for refractory KD(P0.05).They had a higher prevalence of CAL at the acute phase(P0.01).Children with refractory KD were retreated with a second IVIG of 2 g/kg in 12 patients with 10 responding(83.3%).Steroid was used in 2 children with both responding.Conclusion:The incidence of refractory KD in Nanjing Children's Hospital is 4.27%.ESR,WBC and percentage of neutrophil are risk factors for refractory KD.Refractory KD has a higher prevalence of CAL at the acute phase.Retreated of children with refractory KD with a 2 g/Kg IVIG is probably more effective.For those who remain febrile after two doses of IVIG can pulse methylprednisolone.