Indian Academy of Pediatrics Position Paper on Kawasaki Disease

Position Paper on Kawasaki Disease in India: Pertinent Issues

“…It is mentioned that it may take 36-48 hours for the fever to subside in IVIG-responsive patients [1]. However, both this position paper and the AHA statement define IVIG resistance as persistence or recurrence of fever 36 hours after the end of IVIG infusion.…”

“…We are in agreement with the author that NT-pro-BNP is not a well established tool for the diagnosis of KD. As rightly pointed out, NT-pro-BNP varies with age and the values provided in the paper are from the study by Dahdah, et al [1]. It must be said that one should refer to age related upper limits of normal and it is also useful to keep in mind to avoid making diagnosis of Kawasaki disease just on the basis of NT-pro-BNP alone.…”

“…We read with interest the recently published IAP position paper on Kawasaki disease (KD) [1]. We would like to highlight the following issues that require further consideration.…”

“…This is a pertinent issue that needs further exploration, considering that the time taken for IVIG infusion itself can be variable (typically 12 hours in North America and 20-24 hours in Japan) [5]. AHA recommends IVIG infusion over 10-12 hours (as opposed to 12-24 hours recommended by the authors) [1,2].…”

“…There are certain variations in the definition of recurrence. Recurrent KD is defined as a repeat episode of KD after complete resolution of the first episode [1,2]. Acute illness in KD usually lasts for 4 to 6 weeks and several Japanese surveys have classified KD as recurrent if there is an interval of at least two months from the onset of the first illness to onset of the new episode [6].…”