Frequency of Life-Threatening Diabetic Ketoacidosis Related Complications among Pediatric Icu Patients Admitted Pre- and Postcovid- 19 Pandemic: A Single Center Experience

ABSTRACT

BACKGROUND AND AIM: The COVID-19 pandemic has been associated with an increase in the frequency and severity of new-onset diabetic ketoacidosis (DKA) in children (<18). We aimed to compare the incidence of life-threatening DKA complications among patients admitted to our pediatric intensive care unit (PICU) with new-onset DKA presenting pre- and post-the COVID-19 pandemic. METHOD(S) Retrospective observational study of children (0-18 years) admitted to our PICU with a diagnosis of newonset DKA between March 2018 and December 2020. Life-threatening DKA complications were defined as cerebral edema (defined as requiring hyperosmolar therapy and/ or cerebral imaging), respiratory failure requiring invasive mechanical ventilation, shock or hypotension requiring vasopressors, cardiac arrhythmias, cardiac arrest or death. Data was obtained by review of medical records. Analysis was performed using Chi-squared test, and Fisher's exact test where appropriate. RESULT(S) A total of 274 pediatric patients were admitted to our PICU with new-onset DKA between March 2018 and December 2020. There was a total of 12 life-threatening DKA complications among the pre-pandemic cohort (n=157) who presented between March 2018-February 2020. In comparison, there were 27 life-threatening complications among the post-pandemic cohort (n=117) who presented between March-December 2020. The difference was statistically significant (p= 0.0018). However, when analyzed individually, differences among cerebral edema (p=0.066), respiratory failure requiring mechanical ventilation (p=0.77) and shock (p=0.17) failed to reach statistical significance. This is likely due to the low overall incidence in which these individual complications occur. CONCLUSION(S) Following the COVID-19 pandemic we observed an overall increase in the incidence of lifethreatening DKA complications among pediatric ICU patients.