Monitoring
Patients will be discharged home on high-dose aspirin if afebrile for 24 hours. C-reactive protein should be repeated within 1 week and, if normalised, aspirin dosing will be switched to low-dose regimen. These patients should be followed up by a cardiologist. The number of patients with myocardial and vascular complications in adulthood, however, has decreased since the introduction of intravenous immunoglobulin (IVIG) treatment.[83] The American College of Rheumatology/Vasculitis Foundation recommends that patients should be monitored daily for fevers (defined as an oral temperature in older children and a rectal temperature in infants of >38.0°C or an axillary temperature of >37.5°C) for 2 weeks following discharge. In addition, parents or guardians should be instructed on how to take a temperature and told to contact the physician should fever recur.[37]
In addition:
Patients who presented with the classic manifestations of KD and had an uncomplicated disease course can be followed-up with echocardiogram at 8 weeks. If normal, low-dose aspirin can be discontinued. Patients with coronary artery aneurysms (CAAs) should be referred to cardiology.
Patients who presented with the classic manifestations of KD, but with a more protracted course of fever, should be followed-up with echocardiogram at 2 weeks. If normal, follow-up should be rescheduled for 6-8 weeks from disease onset and, if the echocardiogram is normal, low-dose aspirin can be discontinued and no further follow-up is needed. If CAAs are detected at any stage, refer to cardiologist.
Screen all children who have had KD with coronary artery aneurysms for lipid disorders beginning at age 2 years, and for the development of hypertension.[74]
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