Relationship between the heterogeneity of Kawasaki disease and patient cognitive development, stress from nursing staff

A higher educational level of caregivers for children with Kawasaki disease (KD) is associated with lower levels of parental stress, but most caregivers for children with KD who develop coronary artery lesions (CALs) still report increased levels of stress in comparison, according to the study on the general population results published in BMJ Open. In addition, neither intravenous immunoglobulin (IVIG) treatment nor CAL were associated with the cognitive profile of patients with KD.

This case-control study included 176 children with KD (mean age 5.5 years) and 85 healthy participants (mean age 6.4 years). To assess cognitive impairment, the study researchers administered the Mullen Scales of Early Learning to patients under 4 years of age and the Wechsler Intelligence Scale to patients between 4 and 7 years of age. Those older than 7 years received the Wechsler Intelligence Scale for Children-Fourth Edition.

Caregivers also completed the Parenting Stress Index (PSI) short form to assess parental function and stress associated with KD management.

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Caregivers of children with KD who developed CAL had significantly higher levels of parental stress compared to carers of children without CAL (P = .019). In addition, caregivers with a master’s degree or higher education had significantly less parental stress than those with only a bachelor’s degree (P = .01) or lower (P = .021).

No differences were found between the patients and the healthy control group with regard to the development index, cognitive function or educational stress. There was also no association between IVIG administration or CAL and the cognitive score of patients with KD.

Limitations of the study were the small sample size and the case-control design, which limited the researchers’ ability to draw causal relationships.

While multisystem vasculitis and potential brain blood perfusion in patients with KD can increase the stress levels of caregivers, the study did not provide definitive conclusions about how best to manage this stress or whether this stress affects patient outcomes.

Given that “caregivers of patients with KD who have had CAL may experience stress from unpredictable sequelae from CAL,” investigators in this study suggested that carers for children with KD “need support or help in their parenting roles to fulfill “.


Wang LJ, Tsai ZY, Chang LS, Kuo HC. Cognitive development of children with Kawasaki disease and the stressful parenting of their caregivers in Taiwan: a case-control study. BMJ open. 2021; 11 (6): e042996. doi: 10.1136 / bmjopen-2020-042996

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