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. Though there has been a global
effort to identify a suitable biomarker for KD diagnosis, but that still
remains elusive. NT-pro-BNP is presently an accessible tool in many
centers and the facts relating to this tool has been added as an
addendum in the paper.
Regarding the 36 hours (post intravenous
immunoglobulin infusion) being the cut-off for the diagnosis of IVIg
resistance, it was more of an adaptation from the American Heart
Association (AHA) guidelines [2]. It is important to keep in mind that
this period is after the completion of IVIg infusion and the duration of
the IVIg infusion (10-12 hours vs 12-24 hours) does not matter much. The
longer infusion period would specially apply to the context of
school-going children with the disease when a higher total dose of IVIg
needs to be infused. It needs to be emphasized that in a disease like
KD, it might be useful to overtreat rather than undertreat to prevent
lifelong complications due to coronary aneurysms.
The definition of recurrent KD would essentially mean
a recurrence after documented remission of the first episode of KD
(clinically, echocardiography and laboratory). It goes without saying
that this period would be at least for about 4 to 6 weeks.
This is a position paper on KD providing diagnostic
and therapeutic guidelines for practising pediatricians across the
country. We did not intend to highlight or analyze Indian data.
Moreover, data on KD in India is predominantly emerging from few centres
and not representative of the scenario in the whole country.