臨床小児科: オープンアクセス
オープンアクセス

概要

Effectivity of Pretreatment in Kawasaki Disease

Shigeto Fuse*, Toshihiko Mori, Satoshi Hirakawa, Nodoka Sakurai, Mami Iwasa, Takuroh Itoh, Ryohtaroh Sjimomura, Yuhsuke Iizuka

Background: This study aimed to determine the effect of glycerin enema as a pretreatment before starting treatment of Kawasaki disease (KD). We investigated differences in the duration of fever and the coronary arterial maximum Z score in patients with KD. Methods: This single-center, cohort study had a target population including 181 consecutive patients who were diagnosed with KD between 2017 and 2019 in our institution. The control group (n=86) was treated with the usual treatment (intravenous immunoglobulin) for KD from January 2017 to October 2018. Eighty-six patients with KD in the pretreatment group were also treated with the usual treatment from November 2018 to November 2019. Pretreatment was also performed by glycerin enema (2 ml/kg/dose) before initiation of intravenous immunoglobulin therapy. Results: The median duration of fever (95% confidence interval [CI]) in the control and pretreatment groups was 43.5 (30–53) and 22.0 (19–38) hours, respectively. The difference in duration of fever between the groups was largest within the first 100 hours (Peto–Peto Wilcoxon test, p=0.008 After 4 weeks of treatment, the mean maximum Z score in the pretreatment group (−0.35 ± 0.65) was significantly lower than that in the control group (−0.04 ± 0.95; 95% CI 0.061–0.553, p=0.015). Conclusions: An enema is an effective treatment method in the acute phase of KD. We recommend this pretreatment by enema because this treatment also has a low cost.