The edition · Paediatrics
Forty years of Kawasaki disease points at delay, not the drug
Aneurysms were predicted by age under six months, IVIG resistance and treatment after day 10; hospital sepsis guidelines worldwide are methodologically poor but mostly agree on the time-critical steps; and half of children with familial hypercholesterolaemia miss their LDL goal.
The edition in brief
A single-centre Italian cohort followed 533 children with Kawasaki disease from 1982 to 2025. Acute coronary involvement occurred in 22%, but only the 27 children with medium or giant aneurysms had persistent abnormalities at follow-up. Independent predictors of aneurysm were age under six months (odds ratio 7.64), intravenous immunoglobulin resistance (9.89), immunoglobulin given after day 10 (5.27) and pericardial effusion (3.16); no persistent sequelae occurred in high-risk children treated with interleukin-1 inhibitors. The SENTINEL International study appraised 14 hospital paediatric sepsis guidelines from 13 countries with the AGREE II tool: all were rated low methodological quality, with rigour of development scoring 0 to 50%, yet concordance with the Surviving Sepsis Campaign 2020 standard ranged from 42% to 100% and agreement was high on time to antibiotics, fluid bolus volume and initial investigations. Variation was greatest on steroid indications, at 43%. The Australian National FH Registry reports on 341 children: mean age at enrolment 11.9 years, genetic testing in 52.6%, lipoprotein(a) measured in 33.7%, and only 48.3% reaching the LDL cholesterol goal despite 85.4% being on therapy and only 12.7% on ezetimibe combination. An English cohort of 41,859 paediatric intensive care respiratory admissions found higher admission rates in children of Asian and Black ethnicity, in the most deprived areas, and in areas with the highest cigarette smoke exposure. A pearl covers the fluid bolus in a child with poor perfusion. The edition closes with a meta-analysis of 15 studies finding youth sport specialisation associated with double the odds of injury.
In Kawasaki disease, the aneurysm predictors are mostly about timing
Treat before day 10 and escalate fast in resistance — those are the modifiable halves of aneurysm risk.
Every hospital paediatric sepsis guideline appraised scored low, and most were still right about the urgent parts
Audit what your local sepsis guideline says about fluid choice and steroids; the first-hour steps are probably fine, those two probably differ.
Half of children with familial hypercholesterolaemia were not at their LDL goal
If a child with familial hypercholesterolaemia is above goal on a statin alone, add ezetimibe and test the family.
Where a child lives predicted intensive care admission for respiratory illness
Treat deprivation as a clinical risk factor for deterioration, not only for presentation.
Reassess after every fluid bolus, and write down what changed
Write one line after every bolus saying what it did — the fourth bolus usually happens because nobody wrote down the first three.
Youth athletes who specialise in one sport had double the odds of injury
Advise children to play more than one sport — specialisation carried twice the odds of injury, consistently across age and sex.
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