Bronchopulmonary Dysplasia

What Is Bronchopulmonary Dysplasia?

Bronchopulmonary dysplasia, or BPD, is a serious lung condition that affects mostly babies who:

• Are born more than 10 weeks before their due dates



• Weigh less than 2½ pounds, or 1,000 grams, at birth



• Have breathing problems at birth



• Need long-term breathing support and oxygen

Many of these babies are born with serious respiratory distress syndrome (RDS). Their lungs haven't yet developed enough to make surfactant (sur-FAK-tant). Surfactant is a liquid that coats the inside of the lungs and keeps them open so that the baby can breathe in air once he or she is born.

As a result, these babies are usually put on oxygen and a breathing machine at birth—either a ventilator (also known as a respirator) or a nasal continuous positive airway pressure (NCPAP) machine. This can prevent damage to their brains and other body organs from lack of oxygen. They also are given surfactant.

Most babies with RDS begin to get better within the next 2 to 4 weeks. But some get worse and need more oxygen and/or breathing assistance from a machine. These babies have developed BPD.

The lungs of the babies who are born with RDS and go on to develop BPD are less developed than those of babies with RDS who recover. They usually have fewer and larger alveoli, or air sacs, than other newborns. They also may have fewer tiny blood vessels in the alveoli. The blood vessels are needed to move oxygen from the alveoli into the bloodstream.

These babies also are more likely than other infants to have problems in other parts of their bodies that aren't yet fully developed. These include the heart, kidneys, brain, stomach, intestines, and eyes.

With new and better treatments now available, most babies with BPD get better over time, and many go on to live normal, active lives.

What Causes Bronchopulmonary Dysplasia?

The lungs of babies born more than 10 weeks before they are due are fragile and easily irritated or injured by things in the outside environment during the first hours or days after birth.

Doctors now believe that a baby gets bronchopulmonary dysplasia (BPD) as a result of the way his or her lungs respond to some of these things, including:

• High levels of oxygen. Doctors usually give oxygen to newborns with breathing problems. This is to make sure that their brains, hearts, livers, and kidneys receive enough oxygen to do their jobs. But high levels of oxygen can cause inflammation in the lungs. This can result in injury to the breathing passages. High levels of oxygen also can slow the normal development of the lungs in babies born very early.



• Pressure caused by mechanical ventilation. In the past, doctors usually put newborns who couldn't breathe on their own on mechanical ventilators. These machines apply pressure to push air into the babies' lungs. This pressure can irritate the lungs and cause them to become more inflamed. Mechanical ventilation is a factor in most cases of BPD.



• Doctors try to minimize the injury by using ventilation only when absolutely needed. Today, more and more doctors are putting these babies on nasal continuous positive airway pressure (NCPAP) machines, which don't put the same kind of pressure on the babies' lungs.



• Infections. Infections in babies born early can cause inflammation in their underdeveloped lungs. This narrows the breathing passages and makes it harder for the baby to breathe. Lung infections also increase the baby's need for extra oxygen and help with breathing.

Some doctors think that heredity may be a factor in the development of BPD.

What Are the Signs and Symptoms of Bronchopulmonary Dysplasia?

Most babies who get bronchopulmonary dysplasia (BPD) are born with respiratory distress syndrome (RDS). The signs and symptoms of RDS at birth are:

• Rapid, shallow breathing



• Sharp pulling in of the chest below the ribs with each breath taken in



• Grunting sounds during exhalation



• Flaring of the nostrils during breathing

As a result, these babies usually are put on a breathing machine right away. This is to prevent damage to their brains, hearts, and other body organs from lack of oxygen. These babies also are given surfactant to coat the tiny air sacs and to help prevent their lungs from collapsing.

Doctors can usually diagnose BPD after about 2 weeks. At this point, the baby hasn't started getting better, and he or she needs more oxygen.

Babies with severe BPD may also develop:

• Pulmonary arterial hypertension, continuous high blood pressure in the blood vessels that carry oxygen-poor blood from the right ventricle in the heart to the small arteries in the lungs



• Cor pulmonale, failure of the right side of the heart caused by ongoing high blood pressure in the pulmonary artery and right ventricle

How Is Bronchopulmonary Dysplasia Diagnosed?

It's hard to tell whether a baby with breathing problems has bronchopulmonary dysplasia (BPD) before he or she is about 14 to 30 days old. At this point, the baby should be showing improvement in the breathing problems. Instead, the baby's condition seems to be getting worse and he or she needs more oxygen or help from a breathing machine.

Doctors usually conduct a number of tests on newborns with breathing problems to make sure they diagnose their condition correctly. These tests include:

• Blood tests. Blood samples are checked to see whether the baby has enough oxygen in his or her blood.



• Chest x ray. A chest x ray takes a picture of the heart and lungs. It shows larger areas of air and changes from inflammation or infection. It also shows areas of the lung that have collapsed and may help confirm that the lungs aren't developing normally.



• Echocardiogram. This test uses sound waves to create a moving picture of the heart. Echocardiogram is used to rule out congenital heart defects orpulmonary arterial hypertension as the cause of the breathing problems.

Doctors grade BPD as mild, moderate, or severe, depending on how much extra oxygen the baby needs and how long he or she needs it.

How Can Bronchopulmonary Dysplasia Be Prevented?

You can do certain things to help ensure that your baby isn't born before his or her lungs have developed completely.

They include:

• Seeing your doctor regularly during your pregnancy



• Eating right



• Avoiding tobacco smoke, alcohol, and illegal drugs



• Controlling any ongoing medical conditions you have



• Preventing infection

Your doctor may also recommend that you take progesterone if you had a prior preterm birth. This is a hormone that may help delay delivery.

Your doctor may give you injections of a corticosteroid medicine if it looks as though you may give birth too early. This medicine can speed up surfactant production and development of the lungs, brain, and kidneys in the fetus. Usually, within about 24 hours after you start taking the medicine, the fetus' lungs will work better. They also will respond better to surfactant treatment so that respiratory distress syndrome will not develop after delivery, or it will be relatively mild.

How Is Bronchopulmonary Dysplasia Treated?

The goals of treatment for babies with bronchopulmonary dysplasia (BPD) are to:

• Reduce further injury to the lungs



• Provide nutrition and other support to help the lungs grow and recover

Treatment is done in three stages. They are:

• Treatment for respiratory distress at birth and before doctors know whether the baby has BPD



• Treatment after doctors know the baby has BPD



• Home care after the baby leaves the hospital

Treatment of respiratory distress usually begins as soon as the baby is born, sometimes in the delivery room. Most infants who show signs and symptoms ofrespiratory distress syndrome (RDS) are quickly moved to a special intensive care unit called a neonatal intensive care unit (NICU). There they receive around-the-clock treatment from a group of health care professionals who specialize in treating premature infants.

The most important treatments for RDS are:

• Breathing support



• Surfactant replacement therapy

Breathing Support

These babies usually are put on a breathing machine to help them breathe—either a mechanical ventilator or a nasal continuous positive airway pressure (NCPAP) machine. The ventilator is connected to a breathing tube that runs through the baby's mouth or nose into the windpipe. The ventilator can be set to help a baby breathe or to completely control a baby's breathing. It also is set to give the amount of oxygen the baby needs.

Today, more and more babies are receiving breathing support from an NCPAP machine, which pushes air into the baby's lungs through prongs in the nostrils.

With breathing help, the baby's lungs have a chance to develop. Breathing machines today don't cause as much injury to the airways and lungs as those used in the past.

Surfactant Replacement Therapy

The baby is given surfactant to open his or her lungs until the lungs have developed enough to start making their own surfactant. Surfactant is given through a tube that is attached to the breathing machine, which pushes the surfactant directly into the baby's lungs.

Other Types of Treatment

Other treatments for babies who show signs and symptoms of RDS and haven't yet been diagnosed with BPD include:

• Medicines



• Supportive therapy



• Treatment for patent ductus arteriosus, a condition that affects some premature infants

Medicines

Doctors usually give the baby medicines to reduce swelling in the airways and improve the flow of air in and out of the lungs. These medicines include:

• Bronchodilators to improve the flow of air in and out of the lungs



• Diuretics to help remove extra fluid from the lungs



• Antibiotics to control infections

Supportive Therapy

Treatment in the NICU is designed to limit stress on the baby and meet his or her basic needs of warmth, nutrition, and protection. Such treatment usually includes:

• Using a radiant warmer or incubator to keep your baby warm and reduce the chances of infection.



• Ongoing monitoring of blood pressure, heart rate, breathing, and temperature through sensors taped to the baby's body.



• Using a sensor on a finger or toe to monitor the amount of oxygen in the baby's blood.



• Giving fluids and nutrients through a needle or tube inserted into a vein to prevent malnutrition and promote growth. Nutrition is critical to the growth and development of the lungs. Later, your baby may be given milk through a tube that is passed through his or her nose into the mouth.



• Monitoring fluid intake to make sure that fluid doesn't build up in the baby's lungs.

Once doctors know that the baby has BPD, some or all of these treatments are continued in the NICU:

• Babies with BPD are usually taken off the breathing machine slowly over time. They are often moved from the ventilator to an NCPAP machine until they can breathe on their own. This machine pushes air into the baby's lungs through prongs in the nostrils.



• The baby is likely to continue to need extra oxygen for some time. Once the baby no longer needs help breathing, he or she may get additional oxygen through prongs in the nostrils.



• Babies with moderate to severe BPD have an echocardiogram every 2 to 3 months to check their pulmonary artery pressure.

These babies also may need physical therapy to strengthen their muscles and help their lungs clear out mucus.

Today, most babies with BPD recover. They may spend several weeks or months in the hospital. But the best place for the baby's growth and development is at home with the family where he or she can be in a loving and familiar environment.

After the baby goes home:

• It's important for the parents to know about the symptoms and treatments for BPD. Parents and family members play an important role by being loving and involved with their babies and giving care.



• The baby may continue to have some breathing symptoms and may remain in poor health.



• He or she may still need extra oxygen and a breathing machine.



• He or she needs good nutrition and extra calories because of the extra work involved with breathing.



• Regular checkups and timely vaccinations from a pediatrician (a doctor who specializes in treating children) are important. A pediatrician also can treat any other illnesses that the baby may develop.



• The family also may need social services to help them take care of the baby's medical and nonmedical needs.

What Is Sudden Cardiac Arrest (SCA)?

Sudden cardiac arrest (SCA) is acondition in which the heart suddenly and unexpectedly stops beating. When this happens, blood stops flowing to the brain and other vital organs.

SCA usually causes death if it's not treated within minutes.

Outlook

Ninety-five percent of people who have SCA die from it—most within minutes. Rapid treatment of SCA with a defibrillator can be lifesaving. A defibrillator is a device that sends an electric shock to the heart to try to restore its normal rhythm.

Automated external defibrillators (AEDs), which often are found in public places like airports and office buildings, can be used by bystanders to save the lives of people who are having SCA.

Causes

Most cases of sudden cardiac arrest (SCA) are due to ventricular fibrillation (v-fib). V-fib is a type of arrhythmia (for this please see my article on Wolff-Parkinson-White Syndrome (Arrhythmia). In v-fib, the ventricles (the heart's lower chambers) don't beat normally. Instead, they quiver very rapidly and irregularly.

When this happens, the heart pumps little or no blood to the body. V-fib is fatal if not treated within a few minutes.

Other electrical problems in the heart also can cause SCA. For example, SCA can occur if the rate of the heart's electrical signals becomes very slow and stops. SCA also can occur if the heart muscle doesn't respond to the heart's electrical signals.

Several factors can cause the electrical problems that lead to SCA. These factors include:

• Coronary artery disease (CAD), which reduces blood flow to the heart muscle
• Severe physical stress, which raises the risk for abnormal electrical activity in the heart
• Inherited disorders that disrupt the heart's electrical activity
• Structural changes in the heart that cause electrical signals to spread abnormally

Several research studies are under way to try to find the exact causes of SCA and how to prevent them.

Who Is At Risk?

Each year, between 250,000 and 450,000 Americans have sudden cardiac arrest (SCA). SCA occurs most often in people in their mid-thirties to mid-forties. It appears to affect men twice as often as women.

SCA rarely occurs in children unless they have inherited problems that make them likely to have SCA. Only a very small number of children have SCA each year.

Other Risk Factors

Other risk factors for SCA include:

• A personal or family history of SCA or of inherited disorders that make you prone to arrhythmias
• A history of having arrhythmias
• Heart attack
• Heart failure
• Drug abuse or excessive alcohol intake

How Is Sudden Cardiac Arrest Diagnosed?

Sudden cardiac arrest (SCA) happens without warning. It requires immediate emergency treatment. Doctors rarely can diagnose SCA with medical tests as it's happening.

Instead, SCA often is diagnosed after it happens. Doctors do this by ruling out other causes of a person's sudden collapse.

How Is Sudden Cardiac Arrest Treated?

Emergency Treatment

Sudden cardiac arrest (SCA) requires immediate treatment with a defibrillator. This device sends an electric shock to the heart. The electric shock may restore a normal rhythm to a heart that's stopped beating.

To work well, defibrillation must be done within minutes of SCA. With every minute that passes, the chances of surviving SCA drop rapidly.

Police, emergency medical technicians, and other first responders usually are trained and equipped to use a defibrillator. Call 9–1–1 right away if someone has signs or symptoms of SCA. The sooner help is called, the sooner potentially lifesaving treatment can be done.

How Can Death Due to Sudden Cardiac Arrest Be Prevented?

Ways to prevent death due to sudden cardiac arrest (SCA) differ depending on whether:

• You've already had SCA
• You've never had SCA but are at high risk for the condition
• You've never had SCA and have no known risk factors for the condition

For People Who Have Survived Sudden Cardiac Arrest

If you've already had SCA, you're at high risk of having it again. Research shows that an implantable cardioverter defibrillator (ICD) reduces the chances of dying from a second SCA.

An ICD is surgically placed under the skin in your chest or abdomen. The device has wires with electrodes on the ends that connect to your heart's chambers. The ICD monitors your heartbeat.

If the ICD detects a dangerous heart rhythm, it gives an electric shock to restore the heart's normal rhythm. Your doctor may give you medicine to limit irregular heartbeats that can trigger the ICD.

Implantable Cardioverter Defibrillator

The illustration shows the location of an implantable cardioverter defibrillator in the upper chest. The electrodes are inserted into the heart through a vein.

An ICD isn't the same as a pacemaker. The devices are similar, but have some differences. Pacemakers only give off low-energy electrical pulses. They're often used to treat less dangerous heart rhythms, such as those that occur in the upper chambers of the heart. Most new ICDs work as both pacemakers and ICDs.

For People at High Risk for a First Sudden Cardiac Arrest

If you have severe coronary artery disease (CAD), you're at increased risk for SCA. This is especially true if you've recently had a heart attack.

Your doctor may prescribe a type of medicine called a beta blocker to help lower your risk for SCA. Other treatments for CAD, such as angioplasty or coronary artery bypass grafting, also may lower your risk for SCA.

Your doctor also may recommend an ICD if your risk for SCA is very high.

For People Who Have No Known Risk Factors for Sudden Cardiac Arrest

CAD seems to be the cause of most cases of SCA in adults. CAD also is a major risk factor for angina (chest pain or discomfort) and heart attack, and it contributes to other heart problems.

Following a healthy lifestyle can help you lower your risk for CAD, SCA, and other heart problems.

Healthy Diet and Physical Activity

A healthy diet is an important part of a heart healthy lifestyle. Choose a variety of fruits, vegetables, and grains; half of your grains should come from whole-grain products.

Choose foods that are low in saturated fat, trans fat, and cholesterol. Healthy choices include lean meats, poultry without skin, fish, beans, and fat-free or low-fat milk and milk products.

Choose and prepare foods with little sodium (salt). Too much salt can raise your risk for high blood pressure. Recent studies show that following the Dietary Approaches to Stop Hypertension (DASH) eating plan can lower blood pressure.

Choose foods and beverages that are low in added sugar. If you drink alcoholic beverages, do so in moderation.

Aim for a healthy weight by staying within your daily calorie needs. Balance the calories you take in with the calories you use while doing physical activity. Be as physically active as you can.

Some people should get medical advice before starting or increasing physical activity. For example, talk to your doctor if you have a chronic (ongoing) health problem, are on medicine, or have symptoms such as chest pain, shortness of breath, or dizziness. Your doctor can suggest types and amounts of physical activity that are safe for you.

For more information on following a healthy diet, see the National Heart, Lung, and Blood Institute's (NHLBI's) Aim for a Healthy Weight Web site, "Your Guide to a Healthy Heart," and "Your Guide to Lowering Your Blood Pressure With DASH." All of these resources provide general information about healthy eating.

For more information about physical activity, see NHLBI's "Your Guide to Physical Activity and Your Heart."

Other Lifestyle Changes

Other lifestyle changes also can help lower your risk for SCA. Examples include:

• Quitting smoking. Talk to your doctor about programs and products that can help you quit. Also, try to avoid secondhand smoke.
• Losing weight if you're overweight or obese.
• Treating other health problems, such as high blood pressure, high blood cholesterol, and diabetes.

Bronchitis

What Is Bronchitis?

Bronchitis (bron-KI-tis) is a condition in which the bronchial tubes, the tubes that carry air to your lungs, become inflamed. (For more information on the bronchial tubes and the airways, see the Diseases and Conditions Index How the Lungs Work article.)

People who have bronchitis often have a cough that brings up mucus. Mucus is a slimy substance made by the lining of the bronchial tubes. Bronchitis also may cause wheezing (a whistling or squeaky sound when you breathe), chest pain or discomfort, a low fever, and shortness of breath.

Acute Bronchitis

Infections or other factors that irritate the lungs cause acute bronchitis. The same viruses that cause colds and the flu often cause acute bronchitis. These viruses are spread through the air when people cough. They also are spread through physical contact (for example, on hands that have not been washed). Sometimes bacteria cause acute bronchitis.

Acute bronchitis lasts from a few days to 10 days. However, the cough that occurs may last for several weeks after the infection is gone.

Several factors increase the risk for acute bronchitis. Examples include tobacco smoke (including secondhand smoke), air pollution, dust, and fumes. Avoiding these lung irritants as much as possible can help lower your risk for acute bronchitis.

Most cases of acute bronchitis go away within a few days. If you think you have acute bronchitis, see your doctor. He or she will want to rule out other, more serious health conditions that need medical care.

Chronic Bronchitis

Chronic bronchitis is an ongoing, serious condition. It occurs when the lining of the bronchial tubes is constantly irritated and inflamed.

Bronchitis is "chronic" if you have a cough with mucus on most days for at least 3 months a year and 2 years in a row (without another apparent cause). Smoking is the main cause of chronic bronchitis.

Viruses or bacteria can easily infect the irritated bronchial tubes. When this happens, the condition worsens and lasts longer. As a result, people who have chronic bronchitis also have periods when symptoms get much worse than usual.

Chronic bronchitis is a serious, long-term medical condition. Early diagnosis and treatment, combined with quitting cigarette smoking and avoiding secondhand cigarette smoke, can help people live better with this condition. The chance of complete recovery is low for people who have severe chronic bronchitis.

Symptoms of Bronchitis?

Acute Bronchitis

Acute bronchitis caused by an infection usually develops after you already have a cold or the flu. Symptoms of a cold or the flu include sore throat, fatigue (tiredness), fever, body aches, stuffy or runny nose, vomiting, and diarrhea.

The main symptom of acute bronchitis is a cough. The cough may produce clear mucus (a slimy substance). If the mucus is yellow or green, you may have a bacterial infection as well. Even after the infection clears up, you may still have a dry cough for days or weeks.

Other symptoms of acute bronchitis include wheezing (a whistling or squeaky sound when you breathe), low fever, and chest tightness or pain.

If your acute bronchitis is severe, you also may have shortness of breath, especially with physical activity.

Chronic Bronchitis

The signs and symptoms of chronic bronchitis include coughing, wheezing, and chest discomfort. The coughing may produce large amounts of mucus. This type of cough is often called "smoker's cough."

Diagnosis

Your doctor usually will diagnose bronchitis based on your signs and symptoms. He or she may ask questions about your cough, such as how long you’ve had it, what you’re coughing up, and how much you cough.

Your doctor also will likely ask:

• About your medical history
• Whether you’ve recently had a cold or the flu
• Whether you smoke or spend time around others who smoke
• Whether you’ve been exposed to air pollution, dust, or fumes

Your doctor will use a stethoscope to listen for wheezing (a whistling or squeaky sound when you breathe) or other abnormal sounds in your lungs. He or she also may:

• Look at your mucus to see whether you have a bacterial infection
• Test the oxygen levels in your blood using a sensor attached to your fingertip or toe
• Order a chest x ray, lung function tests, or blood tests

What Causes Bronchitis?

Acute Bronchitis

Infections or other factors that irritate your lungs cause acute bronchitis. The same viruses that cause colds and the flu are the most common cause of acute bronchitis. Sometimes bacteria can cause the condition.

Certain substances can irritate your lungs and airways and raise your risk for acute bronchitis. For example, inhaling or being exposed to cigarette or cigar smoke, air pollution, dusts, vapors, or fumes raises your risk. These lung irritants also can make symptoms worse.

Being exposed to a high level of dust or fumes, such as from an explosion or a big fire, also may lead to acute bronchitis.

Chronic Bronchitis

Repeatedly breathing in fumes that irritate and damage lung and airway tissues causes chronic bronchitis. Smoking is the major cause of this condition.

Breathing in air pollution and dust or fumes from the environment or the workplace also can lead to chronic bronchitis.

People who have chronic bronchitis go through periods when symptoms become much worse than usual. During these times, they also may have acute viral or bacterial bronchitis.

Treatment

The main goals of treating acute and chronic bronchitis are to relieve symptoms and help make breathing easier.

If you have acute bronchitis, your doctor may recommend rest, plenty of fluids, and aspirin (for adults) or acetaminophen to treat fever.

Antibiotics usually aren't prescribed for acute bronchitis. This is because they don't work against viruses—the most common cause of acute bronchitis. However, if your doctor thinks you have a bacterial infection, he or she may prescribe antibiotics.

A humidifier or steam can help loosen mucus and relieve wheezing and limited air flow. If your bronchitis causes wheezing, you may need an inhaled medicine to open your airways. You take this medicine using an inhaler. This device allows the medicine to go right to your lungs.

Your doctor also may prescribe medicines to relieve or reduce your cough and treat your inflamed airways (especially if your cough persists).

To lower your risk of getting bronchitis, your doctor also may suggest a flu shot and/or a pneumonia vaccine (if you're aged 60 or older).

If you have chronic bronchitis and have also been diagnosed with COPD (chronic obstructive pulmonary disease), you may need medicines to open your airways and help clear away mucus. These medicines include bronchodilators (inhaled) and steroids (inhaled or pill form).

Sometimes people who have chronic bronchitis need oxygen therapy to help them breathe better and get enough oxygen to their bodies.

One of the best ways to treat acute and chronic bronchitis is to remove the source of irritation and damage to the lungs. If you smoke cigarettes, it's very important to quit. Talk to your doctor about programs and products that can help you quit smoking. Try to avoid secondhand smoke. Also, try to avoid places with a lot of dusts, fumes, vapors, or air pollutants.

Links to Other Information About Bronchitis

Bronchitis (MedlinePlus)

Kawasaki Disease

What Is Kawasaki Disease?

Kawasaki (KAH-wah-SAH-ke) disease is a rare childhood disease. It's a form of a disease called vasculitis (vas-kyu-LI-tis).

In Kawasaki disease, the walls of the blood vessels throughout the body become inflamed. The disease can affect any type of blood vessel in the body, including the arteries, veins, and capillaries.

Overview

The cause of Kawasaki disease isn't known. The body's response to a virus or infection combined with genetic factors may cause the disease. However, no specific virus or infection has been found, and the role of genetics isn't known.

The disease can't be passed from one child to another. Your child won't get it from close contact with a child who has the disease. Also, if your child has the disease, he or she can't pass it on to another child.

Kawasaki disease affects children of all races and both genders. It occurs most often in children of Asian and Pacific Island descent. It's more likely to affect males, and most cases occur in children younger than 5 years.

One of the main symptoms of this disease is a fever that lasts longer than 5 days. The fever remains high even after treatment with standard childhood fever medicines. Children with the disease also may have red eyes, red lips, and redness on the palms of their hands and soles of their feet. These are all signs of inflamed blood vessels.

Early treatment is important. It helps reduce the risk that Kawasaki disease will affect the coronary arteries and cause more serious problems.

Outlook

Kawasaki disease can't be prevented. However, most children who develop Kawasaki disease fully recover—usually within weeks of getting symptoms. Further problems are rare.

In some children, the disease affects the coronary arteries. This can cause serious problems. These children need long-term care and treatment.

How Is Kawasaki Disease Treated?

Kawasaki disease is mainly treated with medicines. Rarely, medical procedures and surgery may be used for children whose coronary arteries are affected.

The goals of treatment are to:

• Lower fever and reduce inflammation to improve symptoms
• Prevent the disease from affecting the coronary arteries

Initial Treatment

Kawasaki disease can cause serious complications. Therefore, your child will likely be treated in a hospital, at least for the early part of the treatment.

The standard treatment during the disease's acute phase is high-dose aspirin and immune globulin. Immune globulin is a medicine given intravenously (injected into a vein).

Most children who receive these treatments improve greatly within 24 hours. For a small number of children, fever remains. In these cases, a second round of immune globulin may be given.

At the start of treatment, high doses of aspirin are given. As soon as your child's fever goes away, a low dose of aspirin is given. The low dose helps prevent blood clots, which can form in the inflamed small arteries.

Most children treated for Kawasaki disease fully recover from the acute phase and don't need any further treatment. They should, however, follow a healthy diet and adopt healthy lifestyle habits to lower their risk for future heart disease (this is advised for all children, not just those who have the disease).

Children who have had immune globulin should wait 11 months before having the measles and chicken pox vaccines. Immune globulin can prevent those vaccines from working properly.

Long-Term Care and Treatment

If Kawasaki disease has affected your child's coronary arteries, he or she will need ongoing care and treatment. It's best if a pediatric cardiologist provides this care to reduce the risk of severe heart problems. A pediatric cardiologist is a doctor who treats children who have heart problems.

Medicines and Tests

When Kawasaki disease affects the coronary arteries, they may expand and twist. If this happens, your child's doctor may prescribe anticoagulants (like warfarin) to prevent blood clots from forming in the affected coronary arteries.

Anticoagulants usually are stopped after the coronary arteries heal. Healing may occur about 18 months after the acute phase of the disease.

For the small number of children whose coronary arteries don't heal, routine tests are needed. These include:

• Echocardiography. This test uses sound waves to create images of the heart.
• EKG (electrocardiogram). This test detects and records the heart's electrical activity.
• Stress test. This test gives the doctor information about how the heart works during physical activity or stress.

Medical Procedures and Surgery

Rarely, a child may need cardiac catheterization (KATH-e-ter-i-ZA-shun). This procedure is used to diagnose and treat some heart conditions. A long, thin, flexible tube called a catheter is put into a blood vessel in the arm, groin (upper thigh), or neck and threaded to the heart. Through the catheter, doctors can perform diagnostic tests and treatments on the heart.

Very rarely, a child may need to have other procedures, or even surgery, if inflammation narrows his or her coronary arteries and blocks blood flow to the heart. Coronary angioplasty (AN-jee-oh-plas-tee), stent placement, or coronary artery bypass grafting(CABG) may be used.

Coronary angioplasty restores blood flow through a narrowed or blocked coronary artery. A thin tube with a balloon on the end is threaded through a blood vessel in the arm or groin (upper thigh) to the narrowed or blocked coronary artery. The balloon is then inflated to widen the artery and restore blood flow.

A stent may be placed in the coronary artery during angioplasty. Stents are small mesh tubes. They're used to keep narrowed or weakened arteries open. Stents can help improve blood flow and prevent the artery from bursting.

Rarely, a child may need to have CABG. This surgery is used when a coronary artery is severely blocked. During CABG, a healthy artery or vein from another part of the body is connected, or grafted, to the blocked coronary artery. The grafted artery or vein bypasses (that is, it goes around) the blocked part of the coronary artery. This improves blood flow to the heart.