Intravenous gamma-globulin treatment and retreatment in Kawasaki disease. US/Canadian Kawasaki Syndrome Study Group

Pediatr Infect Dis J. 1998 Dec;17(12):1144-8. doi: 10.1097/00006454-199812000-00009.


Objective: To determine the prevalence and outcome of intravenous gamma-globulin (IVIG) retreatment in patients with Kawasaki disease (KD).

Method: Multicenter, retrospective survey of all children with KD evaluated at nine clinical centers across North America during a 15-month period.

Results: Data were available for 378 patients. At 48 h after completion of the initial IVIG infusion, 50 patients (13.2%) remained febrile, 29 (58.0%) of whom were retreated with IVIG, including 4 (13.8%) with coronary artery abnormalities before their first IVIG infusion. Among 25 retreated patients with a normal baseline echocardiogram, 5 (20.0%) developed coronary abnormalities and were termed "treatment failures." Among the 323 patients with a normal baseline echocardiogram, only 9 (2.8%) were treatment failures; treatment failure occurred in 4 of 282 (1.4%) patients who became afebrile post-IVIG and in 5 of 41 (12.2%) patients with persistent or recrudescent fever after their first course of IVIG therapy (P=0.002).

Conclusions: The overall prevalence of new coronary abnormalities in KD patients treated with IVIG and aspirin remains low. Persistent or recrudescent fever after the first course of IVIG was associated with an increased risk of treatment failure (P=0.002). IVIG retreatment in patients who remain febrile after the first course of IVIG is now common (58.0%), although the efficacy of this practice requires assessment with a randomized trial.

Publication types

  • Comparative Study

MeSH terms

  • Chi-Square Distribution
  • Child
  • Child, Preschool
  • Data Collection
  • Drug Administration Schedule
  • Female
  • Humans
  • Immunoglobulins, Intravenous / administration & dosage*
  • Infant
  • Male
  • Mucocutaneous Lymph Node Syndrome / diagnosis
  • Mucocutaneous Lymph Node Syndrome / drug therapy*
  • Mucocutaneous Lymph Node Syndrome / epidemiology
  • North America / epidemiology
  • Prevalence
  • Prognosis
  • Retrospective Studies
  • Treatment Outcome


  • Immunoglobulins, Intravenous