Epidemiological and clinical features of Kawasaki disease in Spain over 5 years and risk factors for aneurysm development. (2011-2016): KAWA-RACE study group

Background: Kawasaki disease (KD) is an acute self-limited systemic vasculitis of unknown etiology affecting mainly children less than 5 years of age. Risk factors for cardiac involvement and resistance to treatment are insufficiently studied in non-Japanese children. Objective: This study aimed to investigate the epidemiology, clinical features and risk factors for resistance to treatment and coronary artery lesions (CAL) in KD in Spain. Methods: Retrospective study (May 2011-June 2016) of all patients less than 16 years of age diagnosed with KD included in KAWA-RACE network (84 Spanish hospitals). Results: A total of 625 cases were analyzed, 63% were males, 79% under 5 year-olds and 16.8% younger than 12 months. On echocardiographic examination CAL were the most frequent findings (23%) being ectasia the most common (12%). Coronary aneurysms were diagnosed in 9.6%, reaching 20% in infants under 12 months (p 900,000 cells/mm3, maximum temperature 10 days and fever before treatment ≥ 8 days as independent risk factors for developing coronary aneurysms. Conclusions: In our population, children under 12 months develop coronary aneurysms more frequently and children with KD with anemia and leukocytosis have high risk of cardiac involvement. Adding steroids early should be considered in those patients, especially if the treatment is not started before 8 days of fever. A score applicable to non-Japanese children able to predict the risk of aneurysm development and IVIG resistance is necessary

Prevalence and Clinical Characteristics of SARS-CoV-2 Confirmed and Negative Kawasaki Disease Patients During the Pandemic in Spain

Introduction: COVID-19 has a less severe course in children. In April 2020, some children presented with signs of multisystem inflammation with clinical signs overlapping with Kawasaki disease (KD), most of them requiring admission to the pediatric intensive care unit (PICU). This study aimed to describe the prevalence and clinical characteristics of KD SARS-CoV-2 confirmed and negative patients during the pandemic in Spain. Material and Methods: Medical data of KD patients from January 1, 2018 until May 30, 2020 was collected from the KAWA-RACE study group. We compared the KD cases diagnosed during the COVID-19 period (March 1-May 30, 2020) that were either SARS-CoV-2 confirmed (CoV+) or negative (CoV-) to those from the same period during 2018 and 2019 (PreCoV). Results: One hundred and twenty-four cases were collected. There was a significant increase in cases and PICU admissions in 2020 (P-trend = 0.001 and 0.0004, respectively). CoV+ patients were significantly older (7.5 vs. 2.5 yr) and mainly non-Caucasian (64 vs. 29%), had incomplete KD presentation (73 vs. 32%), lower leucocyte (9.5 vs. 15.5 × 109) and platelet count (174 vs. 423 × 109/L), higher inflammatory markers (C-Reactive Protein 18.5vs. 10.9 mg/dl) and terminal segment of the natriuretic atrial peptide (4,766 vs. 505 pg/ml), less aneurysm development (3.8 vs. 11.1%), and more myocardial dysfunction (30.8 vs. 1.6%) than PreCoV patients. Respiratory symptoms were not increased during the COVID-19 period. Conclusion: The KD CoV+ patients mostly meet pediatric inflammatory multisystem syndrome temporally associated with COVID-19/multisystem inflammatory syndrome in children criteria. Whether this is a novel entity or the same disease on different ends of the spectrum is yet to be clarified

Importancia de los parámetros de la repolarización ventricular en el electrocardiograma en la enfermedad de Kawasaki

Tesis inédita presentada en la Universidad Europea de Madrid. Facultad de Ciencias Biomédicas de la Salud. Programa de Doctorado en Biomedicina y Ciencias de la SaludIntroducción: La enfermedad de Kawasaki (EK) es una vasculitis aguda autolimitada que afecta a vasos de pequeño y mediano calibre. Es la causa más común de enfermedad cardiaca adquirida en niños en nuestro medio. Hasta un 25% de pacientes no tratados desarrollan aneurismas coronarios. El diagnóstico debe ser rápido, basado en criterios clínico y con el apoyo de pruebas complementarias. Entre el 10-20% de los pacientes no responden al tratamiento habitual con inmunoglobulina intravenosa y serán más susceptibles de desarrollar lesiones coronarias. Los niños con alteraciones coronarias tienen un mayor riesgo de presentar infarto de miocardio y arritmias ventriculares que pueden desencadenar muerte súbita. El ECG es una técnica de fácil realización, reproducible, de escaso coste y alta disponibilidad en cualquier centro médico. El índice Tp-Te/QT es el índice que mejor refleja la heterogeneidad ventricular en el ECG basal. Su variación se relaciona con el aumento del riesgo de arritmias ventriculares en adultos. Su conocimiento en niños es limitado. El intervalo QTc es la medida más extendida de la repolarización ventricular en el ECG en la práctica clínica común en niños. Objetivos: Buscar una asociación entre la presencia de afectación coronaria en la EK y el riesgo de arritmias ventriculares mediante la medida manual, y por tanto reproducible, del Indice Tp-Te/QT en el ECG basal que se realiza en la valoración cardiológica reglada de estos pacientes. Ampliar la búsqueda de esta posible asociación con otros intervalos medidos de manera manual en el ECG de estos pacientes. Material y métodos: Estudio transversal de una cohorte de pacientes españoles y japoneses con EK, una cohorte de pacientes sanos y una cohorte de pacientes febriles de distinta etiología a la EK. Resultados: No se encontró una asociación entre el índice Tp-Te/QT obtenido mediante método manual en derivaciones V5 y V6 y la ausencia/presencia de afectación coronaria en pacientes diagnosticados de EK nuestra muestra, ni en el periodo agudo (V5: 0,25 [0,21-0,27] vs 0,25 (0,20-0,27] mseg, p= 0,801; V6: 0,24 (0,21-0,27]vs 0,25 (0,20-0,27] mseg, p=0,863) ni en el periodo de recuperación (V5: 0,23 [0,20-0,25) vs 0,23 [O,19-0,25] mseg, p=0,683; V6: 0,23 [0,20-0,25] vs 0,23 [O,17-0,25] mseg, p=0,498). Se encontró un aumento significativo del índice Tp-Te/QT en los pacientes diagnosticados de EK en el periodo agudo con respecto al periodo de recuperación (V5 : 0,25 [0,21-0 ,27] vs 0,23 [0,20-0,25] mseg, p=0,002; V6: 0,25 (0,20-0,27) vs 0,23 [0,19-0,25] mseg, p=0,046) y en todos los pacientes con EK con respecto a los pacientes sanos (periodo agudo V5: 0,25 [0,21-0,27] vs 0,21 [0,2-0,23] mseg, p=0,001; periodo recuperación V5: 0,23 (0,2- 0,25) vs 0,21 [0,2-0,23) mseg, p=0,001). El intervalo QTc en derivaciones V5 y V6 fue significativamente menor en los pacientes diagnosticados de EK con afectación coronaria en periodo agudo (V5: 378 [364-395) vs 390 [371-411] mseg, p=0,042; V6: 377 [364-392) vs 390 [371;410) mseg, p=0,014). Un intervalo QTc < 385 mseg en derivación V6 se asocia con un aumento de riesgo de 2,5 veces de tener afectación coronaria (OR: 2.5 [1.2;5.3], p=0,016). En pacientes sanos vs febriles un intervalo QTc < 392 mseg, se asocia 2,1 veces más a ser paciente febril (OR: 2,1[1,28;3,64], p= 0,0003). Conciusiones: No existe una asociación entre el índice Tp-Te/QT y la presencia de afectación coronaria en pacientes con EK. Existe un aumento del índice Tp-Te/QT y, por tanto, mayor riesgo de arritmias ventricular es, en pacientes con EK en el periodo agudo con respecto a la recuperación y en pacientes con EK en periodo agudo con respecto a los controles sanos. El intervalo QTc podría ser marcador de afectación coronaria en la EK en el periodo agudo en esta enfermedad. El intervalo QTc disminuye con el aumento de la temperatura. (Resumen Teseo)UE

Urine collection methods for infants under 3 months of age in clinical practice

Background: Methods of urine collection used in precontinent children are a controversial issue. Definitive diagnosis of urinary tract infection (UTI) requires an uncontaminated urine culture. We aimed to describe methods used to collect urine for culture in infants under 3 months of age and compare results and contamination rates. Methods: This retrospective observational cohort study included 721 urine cultures collected from infants <3 months of age at the Hospital Universitario Infanta Sofía, Madrid, between January 2016 and December 2019. Urine cultures were compared based on collection technique, sex, and patient age. Results: Median patient age was 36 days and 54.6% were male. In total, 592 (82.1%) samples were collected using clean-catch urine stimulation technique (CCUST), 77 (10.7%) by urethral catheterization (UC) and 52 (7.2%) by urine bag (UB). Positive cultures were obtained in 11.7% (95% confidence interval [CI] 9.1, 14.3) of CCUST samples and in 28.6% (95% CI 18.5, 38.7) of UC samples (p<0.001). The contamination rate was 13.7% (95% CI 10.9, 16.4] for CCUST, 23.1% (95% CI 11.6, 34.6) for UB and 5.2% (95% CI 0.2, 10.2) for UC, with statistically significant differences (p=0.007) between UB and UC collection. Conclusions: CCUST is the most commonly used method in our hospital for collecting urine in infants younger than 3 months. The contamination rate of UC is lower but not significantly different to that of CCUST. Urine collection by CCUST serves as a non-invasive alternative to UC for diagnosis of UTI in infants under 3 months of age in routine clinical practice. Graphical abstract.Sin financiación3.654 JCR (2021) Q2, 36/130 Pediatrics0.864 SJR (2021) Q1, 54/320 Pediatrics, Perinatology and Child HealthNo data IDR 2020UE

Prevalence and Clinical Characteristics of SARS-CoV-2 Confirmed and Negative Kawasaki Disease Patients During the Pandemic in Spain

Coronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Malaltia de Kawasaki (KD); NensCoronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Enfermedad de Kawasaki (KD); NiñosCoronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Kawasaki disease (KD); ChildrenIntroduction: COVID-19 has a less severe course in children. In April 2020, some children presented with signs of multisystem inflammation with clinical signs overlapping with Kawasaki disease (KD), most of them requiring admission to the pediatric intensive care unit (PICU). This study aimed to describe the prevalence and clinical characteristics of KD SARS-CoV-2 confirmed and negative patients during the pandemic in Spain. Material and Methods: Medical data of KD patients from January 1, 2018 until May 30, 2020 was collected from the KAWA-RACE study group. We compared the KD cases diagnosed during the COVID-19 period (March 1–May 30, 2020) that were either SARS-CoV-2 confirmed (CoV+) or negative (CoV–) to those from the same period during 2018 and 2019 (PreCoV). Results: One hundred and twenty-four cases were collected. There was a significant increase in cases and PICU admissions in 2020 (P-trend = 0.001 and 0.0004, respectively). CoV+ patients were significantly older (7.5 vs. 2.5 yr) and mainly non-Caucasian (64 vs. 29%), had incomplete KD presentation (73 vs. 32%), lower leucocyte (9.5 vs. 15.5 × 109) and platelet count (174 vs. 423 × 109/L), higher inflammatory markers (C-Reactive Protein 18.5vs. 10.9 mg/dl) and terminal segment of the natriuretic atrial peptide (4,766 vs. 505 pg/ml), less aneurysm development (3.8 vs. 11.1%), and more myocardial dysfunction (30.8 vs. 1.6%) than PreCoV patients. Respiratory symptoms were not increased during the COVID-19 period. Conclusion: The KD CoV+ patients mostly meet pediatric inflammatory multisystem syndrome temporally associated with COVID-19/multisystem inflammatory syndrome in children criteria. Whether this is a novel entity or the same disease on different ends of the spectrum is yet to be clarified.CG is funded by the Spanish Ministry of Science and Innovation—Instituto de Salud Carlos III and Fondos FEDER (Contrato Río Hortega CM19/00015)

Ventricular Repolarization Parameters and Coronary Involvement in Kawasaki Disease

Objectives: To evaluate electrocardiogram markers to predict coronary involvement in patients with Kawasaki disease by assessing measures of ventricular repolarization parameters on the 12-lead electrocardiogram. Study design: This cross-sectional study included 180 Spanish and Japanese patients ≤14 years of age with Kawasaki disease, with or without coronary involvement, from 2011 to 2016. We manually measured the Tp-Te/QT ratio and QTc interval (with Bazett's formula) in 12-lead electrocardiogram in the acute and recovery period and explored their potential association with coronary involvement. Results: No association was found between Tp-Te/QT ratio obtained manually in V5 and V6 leads and coronary involvement in the acute (V5:0.25 [IQR, 0.21-0.27] vs 0.25 [IQR, 0.20-0.27], P = .80; V6:0.24 [IQR, 0.21-0.27] vs 0.25 [IQR, 0.20-0.27], P = .86) or the recovery (V5: 0.23 [IQR, 0.20-0.25] vs 0.23 [IQR, 0.19-0.25], P = .68; V6: 0.23 [IQR, 0.20-0.25] vs 0.23 [IQR, 0.17-0.25], P = .50) period. By contrast, QTc in V5 and V6 was significantly lower in patients with Kawasaki disease and coronary involvement in the acute period (V5: 378 ms [IQR, 364-395 ms] vs 390 ms [IQR, 371-411 ms], P = .04; V6: 377 ms [IQR, 364-392 ms] vs 390 ms [IQR, 371-410 ms], P = .01). A QTc interval of <385 ms in lead V6 was associated with a 2.5-fold increased risk of coronary involvement (OR, 2.5; 95% CI, 1.2-5.3; P = .02). Conclusions: Manually measured QTc interval may be a marker of coronary disease in the acute period of Kawasaki disease.Sin financiación6.314 JCR (2021) Q1, 9/130 Pediatrics1.111 SJR (2021) Q1, 28/320 Pediatrics, Perinatology and Child HealthNo data IDR 2020UE

Epidemiological and clinical features of Kawasaki disease in Spain over 5 years and risk factors for aneurysm development. (2011-2016): KAWA-RACE study group

KAWA-RACE study group.[Background] Kawasaki disease (KD) is an acute self-limited systemic vasculitis of unknown etiology affecting mainly children less than 5 years of age. Risk factors for cardiac involvement and resistance to treatment are insufficiently studied in non-Japanese children.[Objective] This study aimed to investigate the epidemiology, clinical features and risk factors for resistance to treatment and coronary artery lesions (CAL) in KD in Spain.[Methods] Retrospective study (May 2011-June 2016) of all patients less than 16 years of age diagnosed with KD included in KAWA-RACE network (84 Spanish hospitals).[Results] A total of 625 cases were analyzed, 63% were males, 79% under 5 year-olds and 16.8% younger than 12 months. On echocardiographic examination CAL were the most frequent findings (23%) being ectasia the most common (12%). Coronary aneurysms were diagnosed in 9.6%, reaching 20% in infants under 12 months (p 900,000 cells/mm3, maximum temperature 10 days and fever before treatment ≥ 8 days as independent risk factors for developing coronary aneurysms.[Conclusions] In our population, children under 12 months develop coronary aneurysms more frequently and children with KD with anemia and leukocytosis have high risk of cardiac involvement. Adding steroids early should be considered in those patients, especially if the treatment is not started before 8 days of fever. A score applicable to non-Japanese children able to predict the risk of aneurysm development and IVIG resistance is necessary.CC received a grant from Spanish Society of Paediatric Rheumatology (SERPE), 2015.Peer reviewe