新生儿川崎病1例并文献复习

A Case of Neonatal Kawasaki Disease and Literature Review

目的:探讨新生儿川崎病的临床特点、诊断及治疗。方法:回顾性分析浙江大学医学院附属儿童医院新生儿科收治的1例新生儿川崎病患儿的临床表现、实验室检查、治疗经过,并进行文献复习。结果:患儿,女,29 d,因发热3 d于2017年6月8日入院。查体:双肺呼吸音粗,可及痰鸣音,四肢肢端凉,双下肢可见花斑。辅助检查:白细胞计数5.27×109/L,中性粒细胞百分比75.8%,血红蛋白100 g/L,血小板112×10^(9)/L,超敏C反应蛋白60 mg/L,胸部X线片提示肺炎征象。入院后予以抗感染治疗,患儿体温仍高,颜面部出现红色皮疹,伴结膜充血,指趾端硬肿,患儿发热不退,予以丙种球蛋白静脉滴注,阿司匹林口服对症治疗,患儿病情好转,2次心脏彩超未提示冠状动脉损害,病情好转出院。结论:新生儿川崎病临床表现常不典型,需早期识别,早期治疗。

Objective:To explore the clinical characteristics,diagnosis and treatment of Kawasaki disease in neonates.Methods:Retrospective analysis was conducted on a case of neonatal Kawasaki disease admitted into the department of neonatology of Children’s Hospital,Zhejiang University School of Medicine.The clinical manifestations,laboratory examinations,treatment course and relevant literature were reviewed.Results:The child,female,29 d,was admitted into the hospital on Jun.8,2017 for 3 d of fever.Physical examination revealed coarse breath sounds in both lungs,audible rales,cool extremities,and rash on the lower limbs.Auxiliary examinations showed white blood cell count of 5.27×109/L,neutrophil percentage of 75.8%,hemoglobin of 100 g/L,platelet of 112×10^(9)/L,highly sensitive C-reactive protein of 60 mg/L,and chest X-ray suggested pneumonia.The child received anti-infective therapy upon admission,yet the fever persisted.A red rash appeared on the face,accompanied by conjunctival congestion and swelling of the fingers and toes.Intravenous immunoglobulin and symptomatic treatment with oral aspirin were administered,leading to improvement in the disease condition.Two consecutive cardiac ultrasounds did not reveal coronary artery injury,and the child was discharged with improved clinical status.Conclusion:Kawasaki disease in neonates often presents with atypical symptoms and requires early identification and treatment.