Background and Aims Abnormalities of liver panel (liver function test [LFT]) are frequently documented in patients with Kawasaki disease (KD). We sought to define the spectrum of abnormalities in liver panel tests in children with KD. We studied the characteristics of KD patients who presented with an abnormal liver panel and their response to treatment. Methods We retrospectively reviewed the medical records of all KD patients admitted between 2004 and 2009 with one or more LFTs done at presentation and compared patients with and without at least 1 abnormal liver panel test including alanine aminotransferase, aspartate aminotransferase, gamma glutamyl transferase, and bilirubin. These patients were divided into 2 groups: those with normal LFTs (normal LFT group) and those with at least one abnormal LFT at presentation (abnormal LFT group). Results Of 259 patients, 240 (92.7%) patients with KD reviewed had one or more LFTs performed. One hundred nine (45.4%) had at least 1 abnormal liver panel test. Patients in the abnormal LFT group presented earlier (P = 0.01) and were more likely to have intravenous immunoglobulin (IVIG) resistant disease (P = 0.01). There was no significant difference between groups in development of coronary artery abnormalities or aneurysms. Multivariate analysis identified C-reactive protein and total bilirubin at admission as significant predictors for IVIG resistant disease. Conclusion We report the largest US single center study of the spectrum of liver panel abnormalities in children with acute KD. Abnormalities of LFTs are frequently found in patients with acute KD and children with abnormal LFTs were at higher risk for IVIG resistance.

The majority of CA abnormalities in children with KD were identified in the initial ECHO, during the first week of illness. Earlier diagnosis and treatment is needed to impact the incidence of CA abnormalities in children with KD. Increased clinical suspicion and earlier use of ECHO in the initial workup of children with suspected KD may lead to more rapid diagnosis and treatment.

Gastroenterologists should be aware of gastrointestinal presentations of KD. Unexplained gastrointestinal symptoms in the presence of fever, and 1 or 2 of the major clinical signs of KD, should prompt consideration of KD in the differential diagnosis.

Objective Successful extubation and prevention of reintubation remain primary goals in neonatal ventilation. Our aim was to compare three modalities of postextubation respiratory support—noninvasive positive pressure ventilation (NIPPV), nasal bilevel positive airway pressure (N-BiPAP), and nasal continuous positive airway pressure (NCPAP)—using the RAM cannula in preterm neonates with respiratory distress syndrome (RDS). Our secondary aim was to define the predictors of successful extubation. Study Design A total of 120 preterm neonates (gestational age ≤35 weeks) with RDS who had undergone primary invasive ventilation were randomized to receive either NIPPV, N-BiPAP, or NCPAP. The incidence of respiratory failure in the first 48 hours postextubation, total days of invasive and noninvasive ventilation, duration of hospitalization, and mortality were measured and compared among the three different noninvasive support modalities. Results There were no significant differences in the postextubation respiratory failure rates and the number of days of invasive as well as noninvasive ventilation among the three different support modalities (p ˃ 0.05). The total number of days of mechanical ventilation and the duration of hospitalization were significantly higher in the N-BiPAP group than those in the NCPAP or NIPPV groups (p < 0.05). A gestational age of at least 29 weeks and a birth weight of at least 1.4 kg were predictive of successful extubation with a sensitivity of 98.2% and 85.3% and a specificity of 63.6% and 90.9%, respectively. Conclusion Longer durations of mechanical ventilation and hospitalization were observed with N-BiPAP as a noninvasive mode of ventilation, but there was no significant difference in the extubation failure rates among the three modalities. Gestational age and birth weight were shown to be independent predictors of successful extubation of preterm neonates with RDS. Key Points