Increased detection rate of Kawasaki disease using new diagnostic algorithm, including early use of echocardiography.

OBJECTIVE: To determine the incidence of Kawasaki disease (KD) in Northern France by using new American Heart Association (AHA) criteria. STUDY DESIGN: A 1-year prospective multicenter cohort study was performed in all pediatric departments. Patients <18 years old, who were admitted for prolonged but initially unexplained fever or suspected KD were included. All patients received the standard treatment considered appropriate by their physicians. A descriptive analysis and comparison of patients with complete and incomplete forms of KD were performed. The incidence of confirmed cases of KD (complete and incomplete forms) was calculated. RESULTS: Seventy-seven children were included (39 in whom KD was diagnosed). Of the patients with KD, 26 (67%) met the classic AHA case definition, and 7 (18%) had incomplete KD. Cardiac ultrasound scanning was helpful in the diagnosis of 6 of 7 patients with incomplete KD (86%). The final incidence of confirmed KD was 9 of 100,000 children <5 years of age. In 6 children (15%) the diagnosis of KD was uncertain, but they were successfully treated for it. Coronary disease was identified in 48% of patients with confirmed KD. CONCLUSION: The incidence of KD is higher than previously reported, in part because earlier reports did not include incomplete forms. New AHA criteria (laboratory tests and early echocardiography) were helpful for the diagnosis of incomplete forms of KD.

Prediction of outcome after hypoxic-ischemic encephalopathy: a prospective clinical and electrophysiologic study.

OBJECTIVES: To evaluate and compare the predictive value of history, clinical examination, and biologic and electrophysiologic data regarding the prognosis of children with acute hypoxic-ischemic encephalopathy (HIE). STUDY DESIGN: Prospective cohort of 57 consecutive children who were mechanically ventilated for HIE throughout a 3-year period in a tertiary pediatric intensive care unit at a university hospital in France. RESULTS: At 24 hours after admission, 12 patients had died, 3 were awake and 42 showed impaired consciousness or were in a coma, of whom 38% had a favorable outcome. In this group, an initial cardiopulmonary resuscitation duration longer than 10 minutes and a Glasgow Coma Scale <5 at 24 hours after admission were associated with an unfavorable outcome (positive predictive value [PPV] 91%, 100%; sensitivity 50%, 54%). A discontinuous electroencephalogram (EEG), the presence of spikes or epileptiform discharges were associated with an unfavorable outcome (PPV 100% for the 2 criteria; sensitivity 27%, 54%). The bilateral absence of the N20 wave on short-latency sensory evoked potentials (SEPs) had a PPV for unfavorable outcome of 100% (sensitivity 63%). CONCLUSIONS: The clinical assessment combined with EEG and SEPs allow an early prediction of the prognosis of children with HIE.