6월 4일 강의.free

1.6개월 아기 성장발달

이가 난다

출생시체중 2배가된다.

목가누기

다리힘주기

2.6m 발달에 맞는거 sata

pika boo

rolling 시도한다

babbling이 없다

barbinski negative

social interaction을 좋아한다

3.6m 발달에 맞는 거 sata

peek a boo

rolling 시도한다 in table at regular check up (hospital)

babbling 이 없다

absent pincer grasp

social interaction 을 좋아한다

turn head forward to fail sound

4.진단 = Kawasaki disease

Age: Children under the age of 5 are at the highest risk.

Sex: It slightly more frequently affects boys than girls.

Ethnicity: Children of Asian or Pacific Islander descent have the highest rates, with Japanese children seeing the highest incidence.

Mayo Clinic +4

Potential Environmental & Infectious Triggers

Although Kawasaki disease is not contagious, seasonal outbreaks in the late winter and spring strongly suggest that unidentified viral or bacterial infections may trigger the disease in genetically predisposed childre

5.IVIG 먼저 주기

6.Kawasaki질환 치료법 맞는거은?

최근에는 높은 농도의 immunoglobulin으로 치료한다

salicylic therapy한다

The principal goal of treatment for Kawasaki disease is to prevent coronary artery disease and to relieve symptoms. Full doses of intravenous immunoglobulin (IVIG) are the mainstay of treatment.

Admit all patients to the hospital for administration of IVIG and for observation until fever is controlled. Closely monitor cardiovascular function. Once the fever resolves, clinically significant heart failure or myocardial dysfunction is unlikely.

Aspirin has traditionally been part of the standard treatment of this disorder. Although some authors have suggested that aspirin is no longer needed, most experts use high-dose aspirin for a variable period, followed by lower-dose aspirin for its antiplatelet effects. Aspirin is used in patients with small coronary artery aneurysms (CAAs). Dipyridamole is indicated in patients with larger CAAs.

The appropriate treatment of patients who fail to respond to IVIG remains unclear. Severe Kawasaki disease that is resistant to IVIG may benefit from intravenous pulse corticosteroid therapy or infliximab infusion.

Transfer patients with suspected Kawasaki disease to a facility that has clinicians experienced in the care of these patients and a pediatric or adult cardiologist to evaluate the echocardiogram. Some authorities recommend transferring patients who have documented coronary artery aneurysms to a tertiary pediatric facility

7.예상되는 진단 SATA

conjunctivitis

arthritis

가와사키

Gastrointestinal: Abdominal pain, vomiting, diarrhea, or liver inflammation (hepatitis).

Neurological: Extreme irritability, lethargy, or rarely, aseptic meningitis, facial palsy, and seizures.

Joints: Swelling and pain in both small and large joints, which can persist after other symptoms fade.

Other organs: Inflammation can sometimes affect the lungs, pancreas, or kidneys.

8.약물 중재 SATA

aspirin

clopidogrel (혈소판 60만 )

The primary treatment for Kawasaki disease combines Intravenous Immunoglobulin (IVIG) and Aspirin. Administered promptly, this combination drastically lowers the risk of developing heart complications like coronary artery aneurysms

Corticosteroids: Used either as an adjunctive primary therapy (e.g., prednisolone) or a rescue therapy to manage severe inflammation.

Infliximab (Remicade): A monoclonal antibody used as rescue therapy for patients who remain resistant to IVIG and corticosteroids.

Other Immunomodulators: Other options like cyclosporine may be utilized in severe, refractory cases.

9. 가와사끼병에 걸린 증상을 확인시켜주는 증상은?

Cracking lip and strawberry tongue

abdominal distention.

conjunctivitis

nephrotic syndrome

10.Kawasaki Dz로 IVIG 맞고 있는 환아 부모의 말로 맞는 것은?

live vaccine 2세 이후에 vaccine하겠다

11개월에 예정되어 있는 MMR 백신을 skip한다

MI에 대한 걱정을 하지 않아도 된다.

IVIG를 다시 맞을 일은 없을 것이다.