{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,2]],"date-time":"2025-08-02T05:08:48Z","timestamp":1754111328065,"version":"3.41.2"},"reference-count":51,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2022,4,25]],"date-time":"2022-04-25T00:00:00Z","timestamp":1650844800000},"content-version":"vor","delay-in-days":114,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatrics International"],"published-print":{"date-parts":[[2022,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Kawasaki disease (KD) can result in severe coronary artery abnormalities (CAAs). Corticosteroids added to initial standard intravenous immunoglobulin (IVIG) treatment may decrease the risk for these complications. Different corticosteroid regimens (single\u2010day high dose pulse vs multiple lower doses) may contribute to the discrepant results of prior studies.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Using data from the 22nd, 23<jats:sup>rd<\/jats:sup>, and 24th Japanese nationwide KD surveys (2011\u20132016), we identified KD patients who did not have CAAs at first presentation and who were treated with either pulse or multiple\u2010dose corticosteroids as part of their initial treatment. Occurrence of subsequent CAAs and treatment failure were compared between the treatment regimens and adjusted odds ratios were calculated controlling for sex, age group, illness day at first treatment, survey, and recurrent KD.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>There were 782 KD patients who received pulse corticosteroid treatment and 4,817 who received multiple dose treatment. Patients receiving multiple dose treatment were less likely to develop CAAs (5.5% vs 8.3%, OR 0.64; 95% CI: 0.48\u20130.85) or treatment failure (21.4% vs 41.6%; OR: 0.38; 95% CI: 0.33\u20130.45). Adjusted analyses showed similar protective effects of multiple\u2010dose treatment against CAAs (OR: 0.67, 95% CI: 0.51\u20130.90) and treatment failure (OR: 0.39, 95% CI: 0.33\u20130.46).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Multiple\u2010dose corticosteroid combination treatment resulted in substantially improved outcomes in KD patients compared to pulse treatment. For patients who may be at elevated risk of treatment failure or CAA, use of multiple\u2010dose corticosteroids in conjunction with IVIG is likely to provide considerable clinical benefit.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ped.15112","type":"journal-article","created":{"date-parts":[[2021,12,27]],"date-time":"2021-12-27T19:28:12Z","timestamp":1640633292000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["First\u2010line corticosteroids for Kawasaki disease: Pulse versus multiple dose"],"prefix":"10.1111","volume":"64","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5960-7358","authenticated-orcid":false,"given":"Joseph Y","family":"Abrams","sequence":"first","affiliation":[{"name":"Division of High\u2010Consequence Pathogens and Pathology National Center for Emerging and Zoonotic Infectious Diseases Centers for Disease Control and Prevention Atlanta GA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2660-530X","authenticated-orcid":false,"given":"Ryusuke","family":"Ae","sequence":"additional","affiliation":[{"name":"Division of High\u2010Consequence Pathogens and Pathology National Center for Emerging and Zoonotic Infectious Diseases Centers for Disease Control and Prevention Atlanta GA USA"},{"name":"Division of Public Health Center for Community Medicine Jichi Medical University Simotsuke Tochigi Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ryan A","family":"Maddox","sequence":"additional","affiliation":[{"name":"Division of High\u2010Consequence Pathogens and Pathology National Center for Emerging and Zoonotic Infectious Diseases Centers for Disease Control and Prevention Atlanta GA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lawrence B","family":"Schonberger","sequence":"additional","affiliation":[{"name":"Division of High\u2010Consequence Pathogens and Pathology National Center for Emerging and Zoonotic Infectious Diseases Centers for Disease Control and Prevention Atlanta GA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6654-1481","authenticated-orcid":false,"given":"Yosikazu","family":"Nakamura","sequence":"additional","affiliation":[{"name":"Division of Public Health Center for Community Medicine Jichi Medical University Simotsuke Tochigi Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ermias D","family":"Belay","sequence":"additional","affiliation":[{"name":"Division of High\u2010Consequence Pathogens and Pathology National Center for Emerging and Zoonotic Infectious Diseases Centers for Disease Control and Prevention Atlanta GA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2022,4,25]]},"reference":[{"issue":"3","key":"e_1_2_8_2_1","first-page":"178","article-title":"Acute febrile mucocutaneous syndrome with lymphoid involvement with specific desquamation of the fingers and toes in children","volume":"16","author":"Kawasaki T","year":"1967","journal-title":"Arerugi"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.54.3.271"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/ped.13809"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.2188\/jea.JE20110131"},{"key":"e_1_2_8_6_1","article-title":"The global epidemiology of Kawasaki disease: Review and future perspectives","volume":"2017","author":"Lin MT","year":"2017","journal-title":"Glob. 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