Paediatricians, especially those practising in the periphery, should be educated about Kawasaki disease, an acquired heart disease in children, which can be very dangerous if not diagnosed and treated early, says Jane W. Newburger, chief of Cardiology, Children’s Hospital Boston.
With Kawasaki disease emerging in the past two years as the number one acquired heart disease in children in Kerala, it is important that paediatricians in the State are trained to pick up cases early and start treatment, she says.
Dr. Newburger was in the city to participate in the just-concluded 13th annual conference of the Paediatric Cardiac Society.
Dr. Newburger, who is also the professor of Paediatrics, Harvard Medical School and the chair of American Heart Association’s (AHA) Committee on Rheumatic fever, Endocarditis and Kawasaki disease, has been aiming at improving the diagnosis, treatment, and outcome of children with Kawasaki disease. She has also been concentrating on the epidemiology and long term effects of this disease on children.
A world renowned authority on paediatric cardiovascular diseases and an epidemiologist of repute, Dr. Newburger was the inaugural Fellow of American Heart Association. She also won the Distinguished Scientist Award of the American College of Cardiology in 2007.
“In the U.S, we are very good at treating the disease, but failure to diagnose Kawasaki continues to be a problem. It is very easy to miss a case when in a busy practice a paediatrician sees scores of children with viral fever and rashes,” she says.
Early diagnosis and aggressive management of Kawasaki is important because the children could be at risk of developing potentially life-threatening aneurysms (ballooning of an artery, which could burst and lead to severe bleeding) in the coronary artery. In the long term, children who have been affected by Kawasaki disease are especially at risk of developing atherosclerosis early and need to be screened for lipid levels from adolescence.
“We still do not know what causes the disease. It is hypothesised that it is some infectious trigger in the environment because in the U.S., we see a lot many cases of Kawasaki in the winter. Even though we are managing to pick up a large number of cases, we do not know how many children we have been missing,” Dr. Newburger says.
Another major area that Dr. Newburger has been focussing on is improving the quality of life of children who are surviving following surgical treatment for Congenital Heart Diseases (CHD).
“In recent times, there has been a dramatic reduction in the mortality of children with CHD, because we have perfected our cardiac surgical techniques to an extent that the survival of even the tiniest of babies could be ensured. But the other side of the story is that the survivors are left with many neuro-cognitive problems, including learning disorders, a problem recognised as ‘huge’ by the American Heart Association,” says Dr. Newburger.
Most of the neuro cognitive problems following heart surgery is because the heart has to be stopped for the procedure and there is less blood supply to the brain. The ‘cold techniques’ or support mechanisms used to protect the brain might not always be perfect. Also, post operative period following heart surgery is quite critical. The adverse neurological outcome following CHD could also be due to the nature of the abnormality itself or foetal malnutrition.
“The burden of neurological problems faced by child survivors of cardiac surgeries may not be felt in Kerala now because the numbers are still small. But in the U.S., the number of adult survivors of CHD are more than the number of those who have not undergone surgery,” she says.
The incidence of congenital heart defects anywhere in the world is approximately 8 per 1000 live births. Even when tremendous progress has been made by doctors and researchers in understanding the heart, the underlying causes of CHD is still not known, says Dr. Newburger.