Intravenous immunoglobulin (IVIG) infusion in the acute stage is the standard therapy in patients with Kawasaki disease (KD). Although some risk-scoring system made in Japan are widely used, there are few reports that describe the usefulness of risk-scoring systems to predict initial IVIG resistance. This study aimed to investigate which risk-scoring system of KD is the most useful. And this study evaluated the usefulness of N-terminal pro-brain natriuretic peptide (NT-proBNP) as an additional criteria of risk-scoring system. In this study, 228 patients with a diagnosis of KD who received IVIG treatment were viewed retrospectively. Of these 228 patients, 27 were nonresponders who received additional rescue therapy. The Kobayashi score (responders n=201, non-responders n=27) showed statistically significant difference between IVIG-sensitive and IVIG-resistant patients, yielding a sensitivity of 83 % and specificity of 67 %. The Egami score (responders n=201, non-responders n=27) also showed statistically significant difference between IVIG-sensitive and IVIG-resistant patients, yielding a sensitivity of 38 % and specificity of 92 %. The Sano score (responders n=108, non-responders n=15) also showed statistically significant difference between IVIG-sensitive and IVIG-resistant patients, yielding a sensitivity of 52 % and specificity of 90 %. The new risk-scoring system ( Kobayashi risk-scoring + NT-proBNP > 1093 pg/mL, responders n=201, non-responders n=27, high risk ≥ 5 points ) also showed statistically significant difference between IVIG-sensitive and IVIG-resistant patients, yielding a sensitivity of 83 % and specificity of 71 %. This findings show the new risk-scoring system is helpful in determining patients at risk for non-responders to initial IVIG treatment. This study suggest that in patients with high risk defined as ≥ 5 points, risk calculation by new scoring system are likely to fail to the initial IVIG therapy and may require further rescue therapy in Korean Kawasaki disease patients .

Purpose: This study aimed to compare cerebral hemispheric volumes between phar macologic treatment and supportive management of patent ductus arteriosus (PDA). Methods: The study was conducted retrospectively. The subjects of period 1 group were very low birth weight infants whose PDA were treated with pharmacologic closure. Period 2 group were treated with supportive management. Regional brain volumes measured using magnetic resonance imaging were compared between the two groups. Results: A total of 12 infants were included. Their median gestational age was 27 +6 (range: 24 +1 -31 +1 ) weeks and birth weight was 1,065 g (range: 690-1,380). Between the two groups, there was no difference in Apgar score, incidence of bronchopulmonary dysplasia, necrotizing enterocolitis, and culture proven sepsis. The regional brain vol umes such as gray matter (Period 1 [16,627], P=0.94) were not different between the two groups. Conclusion: Regional brain volumes were not different between pharmacological and conservative treatment in infants with PDA. Further well controlled studies are required to evaluate the advantages or disadvantages of supportive management without pharmacologic treatment of PDA.

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