Monitoring
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. Parents or guardians should be instructed on how to take a temperature and told to contact the physician should fever recur.[32]
In addition, patients require monitoring for cardiac complications:
Guidelines recommend routinely repeating ECG and echocardiogram 1-2 weeks after treatment, or sooner for high-risk patients.[13][28] Patients who presented with the classic manifestations of Kawasaki disease (KD) and had an uncomplicated disease course can be followed-up with echocardiogram at 6-8 weeks. If normal, low-dose aspirin can be discontinued.[13][51] Patients with coronary artery aneurysms should be referred to cardiology.
All patients with current or previous aneurysms following KD require lifelong follow-up by a cardiology team within a specialist KD service.[12]
European recommendations suggest that ECG and echocardiography should be performed every 3-6 months in children with coronary artery aneurysms, depending on their severity.[13] The American Heart Association guidelines include a stratification system for long-term follow-up and management based on maximum Z-score (ever measured) and current Z-score (during long-term follow up) to categorise patients by their risk level for development of myocardial ischaemia.[1][28]
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.[80]
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