.jpg "Alireza Fathi, MD, MBA photo")
Alireza Fathi, MD, MBA
Pediatric Critical Care
MemorialCare Miller Childrens Hospital and Womens Hospital Long Beach
Palos Verdes Estates, California
Disclosure information not submitted.
Glenn Levine, MD
Pediatric Intensivist
MemorialCare Miller Childrens Hospital and Womens Hospital Long Beach, United States
Disclosure information not submitted.
Rebecca Hicks, MD
Chief of Pediatric Endocrinology
Miller Children's and Women's Hospital of Long Beach
Long Beach, California, United States
Disclosure information not submitted.
Tricia Morphew, MSc
Biostatistician
Morphew Consulting LLC
Bothell, Washington, United States
Disclosure information not submitted.
Christopher Babbitt, MD
Pediatric Intensivist
MemorialCare Miller Childrens Hospital and Womens Hospital Long Beach
Long Beach, California
Disclosure information not submitted.
Title: Are Pediatric New Onset Diabetics Presenting with More Severe DKA During the COVID Pandemic?
A recent study found the number of children visiting the ED declined during the COVID pandemic, likely due to parental concerns of exposing their child to COVID. Our study was done to determine whether the pandemic and variable access to healthcare had any effect on the severity of DKA in pediatric new onset type 1 diabetic patients. This study is a retrospective cohort analysis comparing pre-pandemic and intra-pandemic patients admitted to the PICU with DKA. A PICU database query identified patients and then a chart review was done to extract clinical data. Phone interviews focusing on the effect of the pandemic were also performed with the families of children admitted from March 2020-21. 51 patients were admitted the year prior to the pandemic and 43 patients during the pandemic with new onset type 1 diabetes and DKA. There was no difference in the median age, weight, PRISM 3, initial blood glucose, BUN or creatinine between the two cohorts. Pandemic patients had more severe acidosis than pre-pandemic patients (pH 7.1 vs. 7.17, p=0.04). While in the PICU, they also had a longer duration of insulin infusion (19 vs 15 hours) and metabolic acidosis (15 vs 12 hours) and increased LOS (1 vs 0.74 days, all p< 0.001). There was no difference in the incidence of cerebral edema or mortality. Only two patients were diagnosed with COVID and there was no difference in any outcome measure. Although 36% of parents believed the COVID pandemic affected their ability to see a physician and delayed the care of their child, no difference in severity of DKA compared to those who did not believe there was a delay was found. Multivariate analysis showed no relationship between severity of acidosis in pandemic patients and patient age or social vulnerability index, but found duration of symptoms was inversely related to acidosis. Each additional day of symptoms reported reduced the odds of severe acidosis by 7% (OR=0.93, 95% CI (0.87, 0.99), p=.027). In conclusion, new onset type one diabetic patients admitted for DKA during the COVID pandemic had more severe acidosis which took longer to resolve, required a longer duration of insulin infusion and a had longer PICU LOS. The most severe had a shorter duration of symptoms. Despite parental concerns in delay of care, we did not find that to be associated with more severe DKA.