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Correspondence

Indian Pediatr 2021;58: 190-191

Position Paper on Kawasaki Disease in India: Pertinent Issues: Authors' Reply

 

Bhaskar Shenoy

Department of Pediatrics, Manipal Hospitals, Bangalore, Karnataka, India.
Email: [email protected]



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. 


 

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