What are the indications for referral to a pediatric cardiologist in cases of suspected Kawasaki Disease?

Indications for referral to a paediatric cardiologist in suspected Kawasaki disease include:

• Children with fever lasting 5 days or longer with clinical features suggestive of Kawasaki disease such as bilateral conjunctival injection without exudate, erythema and cracking of lips, strawberry tongue, erythema of oral and pharyngeal mucosa, oedema and erythema of hands and feet, polymorphous rash, and cervical lymphadenopathy should be considered for specialist assessment.
• Infants under 1 year of age presenting with fewer clinical features but at higher risk of coronary artery abnormalities warrant early cardiology referral.
• Any child with suspected Kawasaki disease should be referred promptly for echocardiography and cardiology evaluation to assess for coronary artery involvement and other cardiac complications.

Early referral is critical because coronary artery abnormalities are the most serious complication of Kawasaki disease and require specialist management.

These recommendations are based on NICE guidance emphasizing the importance of recognizing Kawasaki disease features and the risk of coronary artery abnormalities, especially in young infants, to ensure timely paediatric cardiology involvement ¹.