This　retrospective　study　assessed　the　efficacy　of　initial　treatment　with　intravenous　immunoglobulin　(IVIG),　aspirin,　and　corticosteroids　in　Kawasaki　disease　(KD)　patients　at　risk　for　IVIG　resistance.　Data　from　pediatric　patients　with　KD　between　January　2010　and　December　2019　were　divided　into　the　IVIG-sensitive　and　IVIG-resistant　groups　based　on　treatment　response.　Risk　factors　for　IVIG　resistance　were　identified　through　univariate　analysis.　Outcomes　included　comparison　of　fever　resolution　time,　hospital　stay,　and　coronary　artery　lesion　(CALs)　incidence　at　multiple　intervals　post-treatment.　An　observational　group　(January　2020　to　December　2022)　was　given　additional　methylprednisolone　if　they　exhibited　three　or　more　IVIG　resistance　risk　factors.　The　IVIG-resistant　group　had　a　higher　proportion　of　males　and　significantly　elevated　inflammatory　markers　(CRP,　ESR,　PCT)　and　TBIL,　NT-proBNP　compared　to　the　IVIG-sensitive　group　(all　p　＜　0.05),　while　showing　lower　levels　of　albumin,　ARR　(AST/ALT　ratio),　and　serum　sodium　(all　p　＜　0.05).　Both　the　IVIG-sensitive　and　observational　groups　had　significantly　shorter　fever　resolution　times　and　hospital　stays　than　the　IVIG-resistant　group　(all　p　＜　0.05).　CALs　incidence　was　consistently　higher　in　the　IVIG-resistant　group　across　all　follow-up　periods　(all　p　＜　0.05),　with　significant　differences　observed　between　the　observational　group　and　IVIG-resistant　group　at　1-month,　3-month,　and　6-month　post-treatment　(all　p　＜　0.05).　Notably,　prior　to　treatment,　the　observational　group　had　a　higher　CALs　incidence　compared　to　the　IVIG-sensitive　group　(all　p　＜　0.05).　In　children　with　KD　who　exhibit　≥　3　risk　factors　for　IVIG　non-response,　initial　treatment　with　IVIG,　aspirin,　and　glucocorticoids　can　effectively　reduce　fever　duration,　hospitalization　duration,　and　incidence　of　CALs　and　is　considered　safe.　©　The　Author(s),　under　exclusive　licence　to　Springer　Science+Business　Media,　LLC,　part　of　Springer　Nature　2024.