Mortality in children with Kawasaki disease: 20 years of experience from a tertiary care centre in North India.

Kawasaki disease (KD) is a common vasculitic disorder of childhood. Reported mortality in KD in Japan is 0.014%. We report the clinical and laboratory profile of 4 children who succumbed to KD during the period January 1994 to March 2015 at the Paediatric Allergy Immunology Unit, Advanced Paediatrics Centre, Post Graduate Institute of Medical Education and Research Centre, Chandigarh, India. A total of 460 children were diagnosed with KD based on the American Heart Association criteria. Male to female ratio was 1.96:1 and 106 children were aged 2 years or less. Children with KD received 2 g/kg of intravenous immunoglobulin (IVIg). In addition, aspirin was administered in doses of 30-50 mg/kg/day during the acute phase and 3-5 mg/kg/day thereafter. 2-D echocardiography was carried out once during the acute phase and approximately 6-8 weeks later on follow-up. Four children (2 boys, 2 girls) died during this period and their details were analysed from their clinical records. All 4 were under 2 years of age and had had significant delays in diagnosis and referral. Symptomatic myocarditis was noted in 2 children, while 2 of them had thrombocytopenia. We report a mortality of 0.87% in children with KD. Delays in diagnosis and referral contributed significantly to this mortality. To the best of our knowledge, this is the first report on mortality in KD from any developing nation.