eMedicine Specialties > Emergency Medicine > Pediatric

Pediatrics, Kawasaki Disease: Follow-up

Author: Steven J Parrillo, DO, FACOEP, FACEP, Associate Professor, Emergency Medicine, Jefferson Medical College and Philadelphia College of Osteopathic Medicine; Medical Director, Department of Emergency Medicine, Einstein Elkins Park; Chair, Emergency Management Committee, Albert Einstein Healthcare Network; Medical Director, Disaster Medicine and Management Masters Program, Philadelphia University
Coauthor(s): Catherine V Parrillo, DO, FACOP, FAAP, Clinical Assistant Professor, Department of Pediatrics, Philadelphia College of Osteopathic Medicine
Contributor Information and Disclosures

Updated: Oct 28, 2009

Follow-up

Further Inpatient Care

  • Although some authors advocate a 23-hour observation period, most patients with Kawasaki disease are formally admitted to a pediatric or pediatric cardiology service for aggressive supportive and anti-inflammatory therapy.

Further Outpatient Care

  • Careful follow-up care is necessary in the child who has developed cardiac complications.
    • A pediatric cardiologist should provide follow-up care for the child.
    • The long-term implications for coronary artery disease are unknown at this time.

Inpatient & Outpatient Medications

  • The pediatrician or cardiologist who provides the long-term care monitors aspirin therapy and decides whether or not to use warfarin or heparin.
  • Tumor necrosis factor-alpha blockade with infliximab has been advocated by some in cases of refractory Kawasaki disease (KD).24

Transfer

  • Because of the potential life threats, patients with Kawasaki disease must be admitted to a hospital with a pediatric service.
  • Some authorities recommend transferring those patients with documented coronary artery aneurysms to a tertiary pediatric facility.

Deterrence/Prevention

  • Because the etiology of Kawasaki disease is unknown, there is no method of deterrence. Therapy is directed at prevention of coronary artery aneurysm formation.

Complications

  • The primary complications of Kawasaki disease involve the development and rupture of coronary artery aneurysms. Giant aneurysms may occur and may be resistant to Kawasaki disease therapy. Some recommend coronary artery bypass grafting using arterial grafts that can grow with the child. Transplant has been performed in some children who had large aneurysms in vessels not amenable to bypass.
  • Dehydration may result from fever and anorexia.
  • Hyponatremia secondary to SIADH has been reported in a very young infant.
  • Joint inflammation in the acute phase may limit mobility.
  • Pancreatitis, hydrops (vasculitis) of the gallbladder, hepatitis, meningitis, and orchitis may complicate care.
  • Endovascular ultrasonography has shown that some resolved aneurysms are associated with marked intimal thickening.

Prognosis

  • Those patients who do not develop coronary artery aneurysms recover fully. Recurrence is unusual, occurring in only 1-3% of all cases.
  • The severity of aneurysms determines the prognosis in the remainder. More than half of all aneurysms resolve by the 2-year mark. Endovascular ultrasonography has shown that, even when aneurysms resolve, marked intimal thickening is present. Vessel flow may be abnormal.
  • Some believe that giant aneurysms are likely to thrombose or become stenotic. Studies are ongoing.
  • Coronary artery bypass grafting has been required in some children with severe perfusion deficits. Follow-up of children and adolescents 20-25 years post CABG has shown a 95% survival rate, though some have had to have repeat CABG or PCI.9

Patient Education

  • Parents and other caregivers must understand the need for close pediatric and cardiology follow-up until the disease has fully resolved.

Miscellaneous

Medicolegal Pitfalls

  • Failure to diagnose the disease is the primary medical/legal pitfall.
  • Failure to consider the possibility of incomplete Kawasaki disease could lead to delayed (or missed) diagnosis and treatment with a consequent increased likelihood of coronary artery aneurysms development.
 


More on Pediatrics, Kawasaki Disease

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Differential Diagnoses & Workup: Pediatrics, Kawasaki Disease
Treatment & Medication: Pediatrics, Kawasaki Disease
Follow-up: Pediatrics, Kawasaki Disease
Multimedia: Pediatrics, Kawasaki Disease
References
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References

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Further Reading

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Keywords

Kawasaki disease, Kawasaki disease symptoms, Kawasaki disease treatment, Kawasaki's disease, Kawasaki disease in children, incomplete Kawasaki disease, Kawasaki syndrome, myocardial infarction, myocarditis, acute vasculitic syndrome, coronary artery aneurysms, sudden death

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Contributor Information and Disclosures

Author

Steven J Parrillo, DO, FACOEP, FACEP, Associate Professor, Emergency Medicine, Jefferson Medical College and Philadelphia College of Osteopathic Medicine; Medical Director, Department of Emergency Medicine, Einstein Elkins Park; Chair, Emergency Management Committee, Albert Einstein Healthcare Network; Medical Director, Disaster Medicine and Management Masters Program, Philadelphia University
Steven J Parrillo, DO, FACOEP, FACEP is a member of the following medical societies: American College of Emergency Physicians, American College of Osteopathic Emergency Physicians, American Osteopathic Association, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Catherine V Parrillo, DO, FACOP, FAAP, Clinical Assistant Professor, Department of Pediatrics, Philadelphia College of Osteopathic Medicine
Catherine V Parrillo, DO, FACOP, FAAP is a member of the following medical societies: American Academy of Pediatrics, American College of Osteopathic Pediatricians, and American Osteopathic Association
Disclosure: Nothing to disclose.

Medical Editor

Jeffrey Glenn Bowman, MD, MS, Consulting Staff, Highfield MRI, Columbus, Ohio
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Grace M Young, MD, Associate Professor, Department of Pediatrics, University of Maryland Medical Center
Grace M Young, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Emergency Physicians
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Richard G Bachur, MD, Associate Professor of Pediatrics, Harvard Medical School; Associate Chief and Fellowship Director, Attending Physician, Division of Emergency Medicine, Children's Hospital of Boston
Richard G Bachur, MD is a member of the following medical societies: American Academy of Pediatrics, Society for Academic Emergency Medicine, and Society for Pediatric Research
Disclosure: Nothing to disclose.

 
 
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