Table of Content

15 January 2016 Volume 34 Issue 1

  

Analysis of the clinical features of Ureaplasma urealyticum infection in preterm infants under 34 weeks’ gestation

ZHENG Lajie，SU Weidong，HUANG Yudan

. 2016, 34(1):  1.  doi:10.3969 j.issn.1000-3606.2016.01.001

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　Objective　To investigate the clinical features of Ureaplasma urealyticum (UU) infection in preterm infants under 34 weeks’ gestation. Methods　A total of 232 preterm infants under 34 weeks’ gestation were enrolled. The UU in the lower respiratory tract secretions from infants within 24 hours of admission were detected by real-time fluorescence quantitative polymerase chain reaction. According to the results, infants were divided into positive and negative groups. The differences of the clinical features were compared between two groups. Results　Ninety-seven infants were UU positive in 232 preterm infants. The gestational age and birth weight of the positive group were lower than those of negative group (all P<0.01). The difference in sex, maternal gestational hypertension, prenatal use of hormones and perinatal asphyxia between two groups were not significant (P>0.05). The rates of histologic chorioamnionitis, premature rupture of membranes and vaginal delivery in the positive group were higher than those in the negative group (P<0.01). At 24 and 72 hours after birth, the number of leukocytes and neutrophils in the positive group were significantly higher than those in the negative group (P<0.05). One week after birth, the lung injury was more serious in the positive group than that in the negative group (P<0.05). The rates of re-ventilation during ventilator weaning and needs of ventilator after 10 days were higher in the positive group than those in the negative group. At 28 days after birth, the rate of the bronchial dysplasia was higher in the positive group than that in the negative group (P< 0.05) and the rate of acute respiratory distress syndrome was lower in the positive group than that in the negative group (P<0.05). The rates of retinopathy, periventricular-intraventricular hemorrhage, periventricular leukomalacia, neonatal necrotizing enterocolitis and extrauterine growth retardation were not different between the two groups (all P<0.01). Conclusions　The presence of UU in lower respiratory tract secretions in preterm infants under 34 weeks’ gestation may be associated with premature birth and low birth weight, and may cause chronic lung injury.

Clinical analysis of invasive fungal disease after chemotherapy in childhood acute leukemia

AN Qi, JI Qiang, FANG Daihua, JIN Mingwei, XU Shumei, XUAN Chengmin

. 2016, 34(1):  7.  doi:10.3969 j.issn.1000-3606.2016.01.002

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Objective　To explore the clinical characteristics, diagnosis and prognosis of invasive fungal disease (IFD) after chemotherapy in children with acute leukemia (AL). Methods　The clinical data of 15 AL pediatric patients combined with IFD were retrospectively analyzed. Results　In the 15 pediatric patients, there were 4 cases (26.7%) of confirmed IFD, 8 cases (53.3%) of clinically diagnosed IFD and 3 cases (20.0%) of suspected IFD. The infection sites were lung (8 cases), liver (3 cases including 1 case combined with splenic fungal infection), sinus (2 cases) and fungemia (2 cases). All patients were given antifungal treatment. Four patients achieved complete response and 2 patients achieved partial response. The total effective rate was 40.0% (6/15). One patient was in stable condition and one patient was in progress. The total ineffective rate was 13.3% (2/15). Seven patients died and the total mortality was 46.7% (7/15). Conclusions　The most common IFD in children with AL after chemotherapy is invasive pulmonary fungal infection. The pathological diagnosis of IFD is difficult. IFD is dangerous with high mortality.

Analysis on clinical manifestations and etiology of infective endocarditis in children：35 cases　

JIN Yuting, Yang Ying, HUA Chunzhen

. 2016, 34(1):  10.  doi:10.3969 j.issn.1000-3606.2016.01.003

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Objective　To study the clinical manifestations and etiology of infective endocarditis(IE) in children. Methods　Clinical and etiology data from children with infective endocarditis were collected in Children’s Hospital, Zhejiang University School of Medicine between January 1, 2007 and December 31, 2014. Results　Thirty-five children with IE were diagnosed in the study, 15 were male and 20 femaleand with a mean age of (6.56±0.81) years.There were 23 patients had congenital heart disease (65.7%). Vegetations were found in 24 cases(68.6%), and long-time fever was found in 57.4% of cases. Positive results were identified in 19 patients (54.3%) and 83.3% weregram-positive bacteria, including coagulase-negative staphylococci, streptococcus viridans and enterococcus preparation.Drug sensitivity showed that all gram-positive strains were sensitive to vancomycin. Conclusion　Most of the cases with IE in children had congenital heart disease. The main causes of IE were gram-positive coccus, and vancomycin was effective antibiotics for the treatment of IE.

Clinical analysis of seven cases of hand, foot, and mouth disease combined with Kawasaki disease

ZHANG Yuanda, LI Rongmin, JI Chaoyu, ZHANG Xiaoyan, DONG Qingwei, ZHANG Yu

. 2016, 34(1):  13.  doi:10.3969 j.issn.1000-3606.2016.01.004

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Objective　To analyze the clinical characteristics of children with hand, foot, and mouth disease (HFMD) combined with Kawasaki disease (KD). Methods　Clinical data of 7 pediatric patients with HFMD combined KD were retrospectively analyzed from June 2013 to June 2015. Results　Among this 7 patients, 5 patients were with bulbar conjunctival congestion and 6 patients were with cracked lips and strawberry-like tongue. Two patients met the diagnostic criteria of typical KD, 5 cases met the diagnostic criteria of incomplete KD. The testing results of cerebrospinal fluid from 7 patients all were consistent with viral encephalitis. There were 5 patients with EV71 positive, one patient with CVA16 positive. Six patients had coronary arterial lesions, two patients with right bundle branch block. Conclusion　Most of the children with HFMD combined KD was incomplete KD, complicated with central nervous system infections and coronary arterial lesions.

One case report of Epstein-Barr virus associated hemophagocytic syndrome combined with severe hepatitis　

JIANG Tao, CHEN Weijian, OUYANG Wenxian, TANG Yanfang, YUAN Heli, LI Shuangjie

. 2016, 34(1):  16.  doi:10.3969 j.issn.1000-3606.2016.01.005

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Objective　To understand the clinical and pathological features of Epstein-Barr virus (EBV) associated hemophagocytic syndrome.Methods　The clinical data from one deceased pediatric patient of EBV associated hemophagocytic syndrome combined with severe hepatitis were retrospectively analyzed. The relevant literatures were reviewed. Results　The 1 year and 2 months old patient presented with fever, cytopenia, decreased fibrinogen and natural killer cells, elevated serum ferritin and triglycerides. The abnormal lymphocytes accounted for 5% in blood smear. There were 1.39×108 EBV-DNA copies/ml by fluorescence quantitative detection The autopsy results suggest that the cause of death was multiple organ failure. The EB virus encoded RNAs (EBERs) were detected in liver tissues by in situ hybridization. Approximately 30% lymphocytes were EBERs positive and the hepatocytes were EBERs negative. Conclusions　The patient was confirmed to have EBV associated hemophagocytic syndrome involving multiple organs. However the liver damage was not caused by the direct infection of EB virus.

Clinical study on early gastric residual volume in preterm infants　

　ZHAO Yuan, FENG Qi，WANG Ying, ZHANG Xin, LI Xing, SANG Tian

. 2016, 34(1):  19.  doi:10.3969 j.issn.1000-3606.2016.01.006

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Objective　To evaluate the mean gastric residual volume (GRV) and its safe range in early life of premature infants. Methods　One hundred and sixty-five premature infants, birth weight ≤ 1800 g or gestational age ≤ 32 weeks, admitted from Sep.2013 to Mar. 2015, were fed following a standardized protocol. The GRV of first week after birth was recorded by retention stomach tube. The premature infants were grouped according to body weight and gestational age. The changes of GRV in the early stage of birth of premature infants with different birth weight and gestational age were observed. The relationships between the GRV and the complications and related factors were analyzed. Results　Total of 165 premature infants was qualified. The average early maximum GRV were 3.3 ±2.2 ml/kg. The average GRV in 24 hours after birth were 2.4 ±1.9 ml/kg. There was no significant difference in the early maximum GRV (ml/kg) in different body weight and gestational age groups (P>0.05). The time of gastric retention disappeared was significantly different in different birth weight groups (P<0.05). The longest time of gastric retention appeared was 37.5±17.6 days in infants with birth weight ≤ 1250 g. On a receiver operating characteristic (ROC) curve, infants with the maximum GRV up to 6.2 ml/kg at third days had the risk of gastrointestinal bleeding at the 4-7 days after birth. The area under curves (AUC) was 0.641 (95%CI: 0.500-0.782). There was no significant correlation between the early maximum GRV and the occurrence of neonatal necrotizing entercocolitis in 2-3 weeks after birth. Conclusions　Gastric retention maybe sustained for a long time in premature infants after birth. The lower the birth weight, the longer the duration. The enteral nutrition can be performed under the dynamic monitoring and assessment of GRV. The large volume of GRV may predict the feeding complications.

The relations between early coagulation function and gestational age in premature infants　

XU Falin, CHENG Huiqing, GAO Liang, WANG Caihong, DUAN Jiajia

. 2016, 34(1):  25.  doi:10.3969 j.issn.1000-3606.2016.01.007

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Objectives　To understand the relationship between early coagulation function and gestational age in premature infants, in order to provide evidence for diagnosis and treatment of premature infants. Methods　Perinatal high-risk factors (placental abruption, gestational hypertension, gestational diabetes, spontaneous premature delivery) and general status (age, gender, gestational age, delivery mode, Apgar score) of 451 single premature infants were recorded. Blood coagulation function was detected within 2 hours after birth. The premature infants were divided into three groups according to gestational age, 109 cases in early preterm neonate group, 111 cases in moderate preterm neonate group, and 231 cases in late preterm neonate group. The coagulation function were analyzed and compared among different gestational age groups. Results　There were no difference in perinatal risk factors, such as placental abruption, gestational hypertension, gestational diabetes, and spontaneous premature delivery among three groups (P>0.05). There were significant difference in various coagulation parameters among three groups (P<0.05). The levels of prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen degradation products (FDP), D-dimer (DD) tended to decrease with the gestational age increasing. The level of fibrinogen (FIB) tended to increase with the gestational age increasing. Correlation analysis showed that the levels of PT, APTT, FDP, and DD were negatively correlated with gestational age (P<0.05) and the level of FIB was positively correlated with gestational age (P<0.05). Conclusion　The coagulation function in early life in premature infants is associated with gestational age. The coagulation function of premature infants is in a changing and gradually matured process, which should be monitored dynamically.

Changes in lymphocyte subsets and immunoglobulin in children with Kawasaki disease

DING Yan, YIN Wei, WANG Ruigeng, SUN Dongming, XIA Kun

. 2016, 34(1):  29.  doi:10.3969 j.issn.1000-3606.2016.01.008

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Objective　To explore the clinical value of the analysis of lymphocyte subsets and immunoglobulin in children with Kawasaki disease (KD). Methods　Three hundred and eighty-eight children with KD, 160 children with infectious febrile disease and 85 normal children for well child visit were enrolled. The absolute value and percentage of T lymphocyte subsets, natural killer cells (NK cells) and B lymphocytes were detected by flow cytometry. The serum levels of IgG, IgM, IgA, and complement C3, C4 were assessed by velocity scatter turbidimetry. Results　Compared with infectious febrile children and normal control children, the levels of B cells, complements C3 and ratio of CD4/CD8 cells were significantly increased, the percentage of CD8+T cells and NK cells significantly decreased, and the absolute values of CD3+T cells significantly increased in children with KD (all P < 0.05). Conclusions　Lymphocytes subsets and complements might be used as laboratory index to identify KD and understand the pathogenesis of KD.

Clinical analysis of 23 cases of childhood renovascular hypertension

CHU Zhongxia

. 2016, 34(1):  33.  doi:10.3969 j.issn.1000-3606.2016.01.009

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Objective　To explore the clinical characteristics and treatment of childhood renovascular hypertension. Methods　The clinical data of pediatric patients under 14 years old with renovascular hypertension (RVH) from February 2004 to December 2014 were retrospectively analyzed. Results　Twenty-three pediatric patients (15 boys and 8 girls) with RVH were enrolled. The average age of the patients were 8.5±2.1 years (0.6-14 years). The range of systolic blood pressure was 98.5-159.5 mmHg and the range of diastolic blood pressure was 159.4-217.3 mmHg. The main causes of RVH were renal artery fibromuscular dysplasia and Takayasu arteritis. The first presentation was headache, vomiting and convulsions. The levels of renin, angiotensin and aldosterone in the standing and supine positions were increased in most of the patients. All of the patients were treated with β-blockers, calcium antagonists and angiotensin converting enzyme inhibitors (ACEI). Twenty patients were treated with more than two types of drugs. In 18 patients treated by interventional therapy, 17 maintained normal blood pressure and one had postoperative restenosis. Five patients took ACEI and maintained normal blood pressure. Conclusion　Childhood renovascular hypertension is easy to be misdiagnosed or miss-diagnosed, but the prognosis is good by interventional treatment after diagnosis.

The diagnosis and treatment of the aortopulmonary window combined with anomalous origin of the right pulmonary artery from the aorta and interruption of the aortic arch in children　

　LI Hongyun, XIE Yewei, GONG Jin, LI Xiaobing, GENG Lin, WU Rong, SHEN Li, ZHANG Rufang

. 2016, 34(1):  36.  doi:10.3969 j.issn.1000-3606.2016.01.010

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Objective　To explore the diagnosis and treatment of the the aortopulmonary window (APW) combined with anomalous origin of the right pulmonary artery from the aorta (AORPA) and interruption of the aortic arch (IAA) in children. Methods　The clinical data of one pediatric patient diagnosed of the APW combined with AORPA and IAA in April 2013 was retrospectively analyzed. Results　The 4-month-old female patient was diagnosed with ventricular septal defect in local hospital. The conservative treatment was not effective and the ventilator weaning was not successful. After admission, the echocardiography suggested APW, AORPA, patent ductus arteriosus and severe pulmonary hypertension. The oliguria and the big difference of arterial pressure between upper and lower limbs were presented after surgery. A computed tomography scan showed that the patient also had IAA. After a second surgery, the patient recovered and was discharged. During 28 months of the follow-up, the growth and development of the patient were the same as normal children. Conclusions　APW combined with IAA and AORPA require early surgical procedures after diagnosis. Angiocardiography and other tests should be performed to avoid miss-diagnosis before surgery.

Primary intestinal lymphangiectasia: one case report and literature review

　ZHAO Xuemei, DENG Siyan, ZHU Yu, WAN Chaomin

. 2016, 34(1):  40.  doi:10.3969 j.issn.1000-3606.2016.01.011

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　Objective　To explore the clinical features and prognosis of primary intestinal lymphangiectasia (PIL). Methods　The clinical data from one pediatric patient with PIL was retrospectively analyzed. The relevant literatures were reviewed. Results　The 5-year-old female patient gradually presented with progressive abdominal distension, diarrhea, and general edema after birth. Laboratory tests revealed hypoalbuminemia, lymphocytopenia, and hypogammaglobulinemia. Gastroscopy showed diffuse white spots in duodenum and jejunum. The histopathology confirmed greatly dilated lymphatics in interstitial mucosa. After diagnosis, the intravenous infusion of albumin, diuretic, and dietary adjustment were administrated. The patient quickly relieved and was discharged. Conclusions　PIL is a rare protein-losing enteropathy. The diagnosis of PIL mainly relies on small intestine biopsy. Early diagnosis, early dietary intervention and parenteral nutrition support could improve the symptoms and signs.

One case report of infantile malignant osteopetrosis caused by TCIGR1 gene insertion mutation

　ZHANG Lin

. 2016, 34(1):  43.  doi:10.3969 j.issn.1000-3606.2016.01.012

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　Objective　To study the clinical and genetic features of infantile malignant osteopetrosis. Methods　The clinical data and genetic testing results from one patient of infantile malignant osteopetrosis were analyzed. The related literatures were reviewed. Results　One year and six months old female, whose X-ray radiography showed generalize increased bone mineral density and reduced bone marrow space. The bone density was high in vertebral endplates and low in vertebral intermediate. Genetic testing showed that the heterozygous mutations of C.1450_1451insT c.1451A>T: 484P>P in TCIRG1 gene exon 11 in patient`s father and mother. The patient was homozygous mutation. In addition, a missense mutation c.902C>T, p. Pro301Leu of COL9A1 gene was found in the patient. Conclusion　The diagnosis of infantile malignant osteopetrosis is mainly according to clinical manifestations and genetic testing.

The correlation between endogenous EPO/EPOR mRNA and the white matter damage in brain tissue of neonatal rats

LIU Yan, JIANG Hong, WANG Qian

. 2016, 34(1):  46.  doi:10.3969 j.issn.1000-3606.2016.01.013

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　Objective　To investigate the correlation between the level of endogenous erythropoietin (EPO) mRNA/EPO receptor (EPOR) mRNA and the white matter damage in brain tissue of neonatal rats. Methods　Ten pregnant 15 days Wistar rats, 5 were intraperitoneally injected LPS (300 μg/kg) to make model of cerebral white matter lesions caused by intrauterine inflammation and 5 were intraperitoneally injected same amount of normal saline as control. After the pregnant rats giving birth, 18 newborn rats were selected from experimental group and control group respectively. Cerebral white matter damage in newborn rats was detected by hematoxylin eosin (HE) staining. The level of EPO and EPOR mRNA in the corpus callosum were detected by real time fluorescent quantitative polymerase chain reaction. The levels of CD68, glial fibrillary acidic protein (GFAP), myelin basic protein (MBP) in periventricular white matter were detected by immunofluorescence. The differences between two groups were compared. The correlation of CD68, GFAP, and MBP with MBP, EPO mRNA, and EPOR mRNA, were analyzed. Results 　In experimental group, the structure of periventricular white matter of newborn rats was scattered, with reticular change. The white matter damage was apparent. The levels of CD68, GFAP, EPO mRNA and EPOR mRNA in experimental group were significantly higher than those in control group (P<0.01). Pearson correlation analysis showed that the levels of CD68 and GFAP were positively correlated with the levels of endogenous EPO and EPOR mRNA (r=0.92-0.95, all P<0.01). Conclusion　The expression of endogenous EPOR mRNA rises in white matter damage caused by intrauterine infection in newborn rats, which may be the basis of the protective effect of EPO in brain damage.

Analysis of current situation of the quality of clinical practice guidelines for children with urinary tract infections based on AGREE II

　CHEN Hui, HU Yuhuai, LI Zhenyu, ZHAO Yingting, LUO Lei

. 2016, 34(1):  50.  doi:10.3969 j.issn.1000-3606.2016.01.014

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　Objectives　To evaluate the quality of global clinical practice guidelines for children with urinary tract infection (UTI) and provide reference for the development of the clinical guidelines for Chinese children with UTI. Methods　The Medline, Embase, National Guideline Clearinghouse (NGC), guidelines international network (GIN ), national Institute for Health and Clinical Excellence (NICE), Wanfang database, Chinese national knowledge infrastructure (CNKI), Chinese practice guideline network (CPGN, from inception to January 2015 ), and related English and Chinese websites were searched. The published guidelines for children with UTI were screened according to the inclusion and elimination criteria. AGREE was used to evaluate the methodological quality of the guidelines. The consistency among the assessors was evaluated by correlation coefficient (ICC). Results　A total of 10 guidelines for children with UTI were included, covering 9 continents and 4 organizations. The published time was from 1999 to 2015, including 7 articles in headed version and 3 articles in updated version. The topics of these guidelines were diagnosis, management, prevention, risk assessment and treatment , and were all evidence-based. The AGREE II score of included guidelines showed that the average scores on six domains were 88%, 57%, 54%, 98%, 26% and 44% respectively. The scores in the field of scope, purpose, and clarity in 7 guidelines were > 50%. The scores of guidelines published by National Institute for Health and Clinical Excellence (NICE) of United Kingdom and Aragon Institute of Health Sciences (IACS) were all >50% in six areas. Conclusions　The quality of clinical guidelines for children with UTI in different countries and regions varied greatly. Evidence-based is the trend in the development of clinical practice guidelines. The rigorous methodology, report standardization and practicability of guidelines should be emphasized.

Neonatal hypoglycemia and management

WANG Lei

. 2016, 34(1):  55.  doi:10.3969 j.issn.1000-3606.2016.01.015

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Neonatal hypoglycemia is a common metabolic problem. Regardless of gestational age and birth age, when a blood glucose level <2.2 mmol/L, the diagnoses of neonatal hypoglycemia should be confirmed. when the blood glucose <2.6 mmol/L, the clinical intervention and treatment should be performed. Maintaining glucose homeostasis is an important physiological events during fetal-to-neonatal transition. The transient hypoglycemia are common in this period. However, the persistent or recurrent hypoglycemia may cause acute systemic reactions, affect long-term nervous system development, even lead to permanent brain damage. This paper based on explicit the definition, etiology, classification to discuss the recent advances in management of neonatal hypoglycemia, in order to improve the accuracy of neonatal hypoglycemia diagnosis and to achieve the goal of early prevention, prompt treatment, and reducing the adverse effects of neonatal hypoglycemia.

The roles of microbiota on pediatric intestinal inflammatory diseases　

LI Yuqing, HONG Li

. 2016, 34(1):  59.  doi:10.3969 j.issn.1000-3606.2016.01.016

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　Neonatal necrotizing enterocolitis (NEC), childhood inf lammatory bowel disease (IBD), and Hirschsprung-associated enterocolitis (HAEC) are common intestinal inflammatory diseases in pediatrics, which seriously affecting the quality of life of patients and even posing a threat to life. The mechanism is not clear at present. Studies have shown that intestinal inflammatory diseases closely related to the intestinal flora disturbance. However, approximately 85% of the intestine microbiota cannot be cultured. Recently, the high-throughput sequencing technology is developing rapidly, which makes it feasible to explore the intestinal flora comprehensively. This article reviewed the recent advances on the role of intestinal flora in pediatric inflammatory bowel diseases pathogenesis and the application of probiotics.

Progress in the diagnosis and treatment of Noonan syndrome

LIU Xiaoliang

. 2016, 34(1):  64.  doi:10.3969 j.issn.1000-3606.2016.01.017

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　Noonan syndrome (NS) is an autosomal dominant hereditary disease characterized by distinctive facial features, congenital cardiac defects, short stature, growth retardation, learning disability, and other comorbidities. About 70%-80% of patients with NS were associated with gene mutations (eg, PTPN11) in mitogen-activated protein kinase signal pathway (RASMAPK). In this article, the progress in the pathogenesis, diagnosis, treatment and genetics of NS in recent years was reviewed.

Progress in the treatment of intravenous immunoglobulin-resistant Kawasaki disease

WANG Renjian

. 2016, 34(1):  68.  doi:10.3969 j.issn.1000-3606.2016.01.018

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Kawasaki disease (KD) is a childhood acute febrile illness with systemic vasculitis of an unknown etiology as the main pathological changes. KD often affects the coronary artery and, if not treated in time, the patients may develop coronary artery lesion (CAL). Currently, the standard treatment for the acute phase of KD are intravenous immunoglobulin (IVIG) and oral aspirin. Nevertheless, there are still 10% to 20% of patients unresponsive to IVIG, and risk of CAL was increased in these children. Literatures have reported a variety of therapeutic options for IVIG resistant KD, such as secondary IVIG therapy, glucocorticoid, infliximab, immunosuppressive agents, and plasma exchange. However, the outcomes of these therapies remain inconclusive. This article reviewed the progress in the treatment of IVIG resistant KD.