26 - CANADIAN PRACTICE POINT ON KAWASAKI DISEASE (KD) MANAGEMENT

Background: KD affects 19.6 to 22.0 cases per 100,000 children under 5 years of age in Canada with increasing incidence rates over time. Although general paediatricians diagnose and manage acute KD frequently, cases can be complex with evolving therapeutic paradigms. We present a practice point for Canadian paediatricians to highlight important clinical scenarios in KD management.

Methods: The authors include 1 paediatric cardiologist, 9 paediatric rheumatologists and 2 trainees providing care across 6 provinces. The practice point was developed through consensus with the authors.

Results: We propose a KD management algorithm (Fig 1) that provides suggestions on baseline investigations, features that may require subspecialty consultation for additional management considerations and first-line treatments. We continue to recommend treatment of KD with IVIG 2g/kg, ASA and echocardiography for cardiac evaluation. A practical algorithmic approach for general paediatricians was developed, with the identification of stable or unstable KD as the first decision point, followed by 7 clinical scenarios that may require subspecialty consultation (rheumatology, cardiology): KD shock, macrophage activation syndrome, IVIG-resistant KD, CA lesions on initial echocardiogram, COVID-19 exposure, age < 12 months at presentation and prolonged fever ≥10 days. We describe the use of corticosteroids and other anti-inflammatory modulators in KD and provide recommendations regarding discharge and follow-up.

Conclusion: This Canadian practice point provides practical advice for general paediatricians on the identification of unstable KD patients and patients at risk for poor outcomes; and highlights circumstances where additional management considerations are required. We aim to develop a more comprehensive Canadian guideline on KD in the future.