Long-term hearing and neurodevelopmental outcomes following Kawasaki disease: A population-based cohort study

Cal Robinson; Francis Lao; Rahul Chanchlani; Anastasia Gayowsky; Elizabeth Darling; Michelle Batthish

doi:10.1016/j.braindev.2021.03.001

Long-term hearing and neurodevelopmental outcomes following Kawasaki disease: A population-based cohort study

Brain Dev. 2021 Aug;43(7):735-744. doi: 10.1016/j.braindev.2021.03.001. Epub 2021 Apr 3.

Authors

Cal Robinson¹, Francis Lao², Rahul Chanchlani³, Anastasia Gayowsky⁴, Elizabeth Darling⁵, Michelle Batthish⁶

Affiliations

¹ Department of Pediatrics, McMaster University, Hamilton, ON, Canada; Division of Nephrology, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON, Canada.
² Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada.
³ Division of Nephrology, Department of Pediatrics, McMaster University, Hamilton, ON, Canada; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada; ICES McMaster, Hamilton, Ontario, Canada.
⁴ ICES McMaster, Hamilton, Ontario, Canada.
⁵ McMaster Midwifery Research Centre, McMaster University, Hamilton, ON, Canada.
⁶ Division of Rheumatology, Department of Pediatrics, McMaster University, Hamilton, ON, Canada. Electronic address: batthim@mcmaster.ca.

PMID: 33824025
DOI: 10.1016/j.braindev.2021.03.001

Abstract

Background: Kawasaki disease (KD) incidence is increasing in Ontario. Cardiovascular sequelae following KD are well-described. However, there are limited data on non-cardiovascular outcomes.

Objectives: To determine the risk of hearing loss, anxiety, developmental disorders, intellectual disabilities and attention-deficit/hyperactivity disorder (ADHD) among KD survivors vs. non-exposed children.

Methods: We included all Ontario children (≤18 yr) surviving hospitalization with a KD diagnosis between 1995 and 2018, using population-based health administrative databases. We excluded children with prior KD diagnoses and non-residents. KD cases were matched with 100 non-exposed children by age, sex and year. Follow-up continued until death or March 2019. We calculated the prevalence, incidence and adjusted hazard ratios (aHR [95%CI]) of outcomes between 0-1 yr, 1-5 yr, 5-10 yr and >10 yr follow-up.

Results: Among 4597 KD survivors, 364 (7.9%) were diagnosed with hearing loss, 1213 (26.4%) anxiety disorders, 398 (8.7%) developmental disorders, 51 (1.1%) intellectual disability and 21 (0.5%) ADHD, during median 11 year follow-up. Compared to 459,700 non-exposed children, KD survivors were not at increased risk of hearing loss after adjustment for potential confounders. KD survivors were at increased risk of anxiety disorders between 0-1 yr (aHR 1.75 [1.46-2.10]), 1-5 yr (aHR 1.13 [1.01-1.28]), 5-10 yr (aHR 1.14 [1.03-1.28]) and >10 yr (aHR 1.11 [1.02-1.22]); developmental disorders between 0-1 yr (aHR 1.49 [1.28-1.74]) and 1-5 yr (aHR 1.19 [1.02-1.40]); intellectual disabilities >10 yr (aHR 2.36 [1.36-4.10]); and ADHD >10 yr (aHR 2.01 [1.14-3.57]).

Conclusions: KD survivors are at increased risk of being diagnosed with anxiety disorders sooner, being diagnosed with developmental disorders between 0 and 5 yr and being diagnosed with intellectual disabilities or ADHD >10 yr after KD diagnosis. This may justify enhanced developmental and audiological surveillance of KD survivors.

Keywords: Attention-deficit hyperactivity disorder; Children; Development; Hearing loss; Kawasaki disease.

MeSH terms

Adolescent
Adult
Anxiety Disorders / epidemiology
Anxiety Disorders / etiology*
Attention Deficit Disorder with Hyperactivity / epidemiology
Attention Deficit Disorder with Hyperactivity / etiology
Child
Child, Preschool
Follow-Up Studies
Hearing Loss / epidemiology
Hearing Loss / etiology*
Humans
Infant
Intellectual Disability / epidemiology
Intellectual Disability / etiology
Mucocutaneous Lymph Node Syndrome / complications*
Mucocutaneous Lymph Node Syndrome / epidemiology
Neurodevelopmental Disorders / epidemiology
Neurodevelopmental Disorders / etiology*
Ontario / epidemiology
Retrospective Studies
Risk
Young Adult