“At 4 months, Elisabeth was a very active baby. The day she fell ill, she ran a fever of almost 39 deg C but had no other symptoms. Still, I took her to Thomson Medical as a precaution.
“The GP on duty took her blood and urine samples to check for urinary-tract infection — he concluded that she didn’t have ﬂu. However, since she had an infection, he prescribed some antibiotics and asked us to come back if Elisabeth’s condition did not improve.
“The following day, when paracetamol and sponge baths hadn’t lowered her temperature and she started shivering, my instincts told me something wasn’t right. Since high temperatures in babies can be dangerous, I took her back to Thomson Medical. This time, I asked her paediatrician to admit her, so that the hospital could bring down her temperature.
“Four days later, she started showing other symptoms, such as a rash on her genitals and high irritability. Elisabeth’s eyes looked like she had conjunctivitis, her lips had turned bright red, while the area where she’d had her BCG jab became red and inﬂamed.
“That night, her paediatrician told us that Elisabeth was suffering from Kawasaki disease — swollen blood vessels triggered by a viral infection — and needed to be treated immediately as she was very sick. There aren’t any tests that can conﬁrm your child has it. The diagnosis was based on her symptoms and a blood test to rule out other illnesses, such as scarlet fever.
“Unlike my husband, I hadn’t heard about Kawasaki disease, so on googling it, I was devastated to ﬁnd that it’s the leading cause of heart disease among children. Elisabeth was at risk of developing aneurysms (blood-ﬁlled bulges in blood-vessel walls) in her heart if the treatment didn’t work, since the smaller the baby, the higher the risk of developing this complication. In the worst-case scenario, my daughter would have developed these or other heart issues because of the disease, which would require a lifetime of cardiologist visits.
“Elisabeth’s treatment included intravenous doses of gamma globulin (puriﬁed antibodies, also called immunoglobulin), which helps the body ﬁght infection over 24 hours, as well as a high dose of aspirin for up to a month. It was heartbreaking to see her hooked up to machines and the IV drip — she cried every time the nurses came to take her temperature and give her medication.
“Since I had to be in hospital with Elisabeth 24/7, it was also difficult being away from Emmanuelle. Simultaneously, my husband had to monitor her twin, Emmanuelle, for Kawasaki, since she’s genetically similar to Elisabeth. Though the disease isn’t contagious, it’s believed that children who develop the disease have a genetic predisposition to it.
“I focused on being positive. Thankfully, I also found a mum in Singapore whose son had been diagnosed with Kawasaki. Talking to her helped me understand what to expect once Elisabeth was home. Although Elisabeth was discharged after spending six days in hospital, it took about four months before she returned to normal — she was very needy, and often cried in her sleep. Fortunately, the strong doses of aspirin she was on for a month after her hospital stay worked for her.
“Her echocardiogram — using ultrasound to monitor the heart — three months after her hospital discharge showed that she was free from heart damage. Most children recover fully if Kawasaki is detected in time. If not, some children will develop heart problems, which require follow-ups with a cardiologist. We were lucky that our paediatrician had seen similar cases and was able to treat her in time.
“My advice is to always follow your instincts — see a doctor if you feel something isn’t right with your child and ask him a lot of questions. If necessary, seek a second or a third opinion — something that starts as a normal cold or fever may end up being something serious. In illnesses like Kawasaki, a timely diagnosis can determine whether there’s any long- term impact on your child ’s health.”
Nathalie Yan, lives in the Clementi area with her husband Pascal Pong, and 2-year-old twins, Elisabeth and Emmanuelle.
Kawasaki disease — the facts
Dr Terence Lim Chee Wen, a consultant in the division of paediatric cardiology at the National University Hospital, sheds light on Kawasaki disease.
• Kids below 5 years of age are most at risk, while it’s rare in those above age 10. Though there’s no known cause, there’s speculation that Kawasaki is caused by an unusual immune response to a commonplace micro-organism.
• Symptoms include high fever for several days and any of these signs: Redness in both eyes; changes around the lips/tongue/mouth; a skin rash; puffy hands and feet; a strawberry tongue and swollen lymph nodes in the neck.
• To test for the disease, a doctor monitors the child’s heart rate and performs tests on his heart functions. He’ll also obtain blood and urine samples to rule out other conditions, such as scarlet fever and measles.
• It is treated with intravenous immunoglobulin (IVIg), which brings down the fever and has been proven to reduce the risk of coronary artery complications, from 20 per cent to 3 to 5 per cent. However, a child has a 20 per cent risk of developing swollen coronary arteries (blood vessels supplying oxygen-rich blood to the heart).
• Kawasaki cases are most common in Japan and Korea, while the lowest ﬁgures are seen in the West (in the US, some 19 out of 100,000 kids get the illness). In Singapore, fewer than 40 out of 100,000 children under age 5 get Kawasaki and fatalities are rare.
This story was first published in the December 2014 issue of Mother & Baby Singapore.
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