Serhat EMEKSİZ, Emel UYAR, Oktay PERK, Serhan ÖZCAN

COVİD-19 PANDEMİSİ’NİN ÇOCUK YOĞUN BAKIM ÜNİTESİ YATIŞLARINA ETKİSİ

AMAÇ: Bu çalışmada pandemi döneminde sosyal izolasyon, alınan önlemler ve hastane protokollerinin üçüncü basamak Çocuk yoğun bakım pratiğine etkisini araştırmak amaçlanmıştır. GEREÇ VE YÖNTEM: Çalışmamıza 15 Mart 2020-1 Haziran 2020 tarihleri arasında çocuk yoğun bakım ünitemize kabul edilen hastalar dahil edildi. Demografik özellikler, yatış tanıları, mekanik ventilatöre bağlanma oranları, mekanik ventilatörde kalış süreleri, çocuk yoğun bakım ünitesinde ve hastane yatış süreleri, PRİSM III skorları ve mortalite durumları medikal dosya verilerinden geriye dönük olarak kaydedildi. Elde edilen veriler pandemiden önceki yılın aynı dönemiyle (15 Mart 2019 – 1 Haziran 2019) karşılaştırıldı. BULGULAR: Çocuk yoğun bakım ünitemize pandemi döneminde 200, pandemi öncesi (2019) dönemde 379 hasta kabul edildi ve hasta yatışında %47 oranında bir azalma saptandı. Pandemi öncesi dönem ile pandemi dönemindeki hastaların yoğun bakıma yatış tanıları karşılaştırıldığında, solunum yolu hastalıkları (pnömoni, bronşiolit, astım vb.) ve post-op hasta yatışlarında azalma, diabetik ketoasidoz nedeni ile yatışlarda artış saptandı ve istatistiksel olarak anlamlı farklılık vardı (sırasıyla, p = 0,039; 0,016; 0,039). Ayrıca hastaların pandemi döneminde ortalama mekanik ventilatörde kalış süreleri, hastanede kalış süreleri ve yoğun bakımda kalış sürelerinde azalma saptandı (sırasıyla, p = 0,04;

THE EFFECT OF COVID-19 PANDEMIC ON PEDIATRIC INTENSIVE CARE ADMISSIONS

AIM: This study aimed to investigate the effects of social isolation, precautions, and hospital protocols on tertiary pediatric intensive care unit during the pandemic period. MATERIAL AND METHOD: Patients who were admitted to our pediatric intensive care unit between March 15 2020 and June 01 2020, were included in this study. The demographic characteristics of the patients, hospitalization diagnoses, mechanical ventilation rates, duration of stay inmechanical ventilation, length of stay (LOS) in the pediatric intensive care unit and hospitalization, PRISM III scores, and mortality status were recorded, retrospectively. The data obtained were compared with the same period of the year before the pandemic (March 15 and June 12019). RESULTS: During the pandemic period, the number of patients admitted to the pediatric intensive care unit was 200 while the pre- pandemic (2019) period was 379 patients. We found a 47% decrease in the number of admitted patients during the pandemic period compared to the previous year. When the patients were compared in terms of the diagnoses of PICU admission, a decrease in respiratory tract diseases (pneumonia, bronchiolitis, asthma, etc.) and post-op patient admissions, an increase in hospitalizations due to diabetic ketoacidosis were found, when compared to pre-pandemic period (respectively, p = 0.039; 0.016; 0.039). Inaddition, we found a significant decrease in the duration of stay in the mechanical ventilation during the pandemic period, LOS in pediatric intensive care unit, and hospitalization (respectively, p = 0.04; < 0.001; 0.015). CONCLUSION: We estimate that social distance, wearing masks, closing school and compliance with hygiene rules reduce the risk of infection and this situation causes a decrease in the number of intensive care hospitalizations due to respiratory diseases. Postponing elective surgeries also resulted in a decrease in post-op hospitalizations. In addition, we think that families' reluctance to go to the hospital, delays in the follow-up of the patients with Tip 1 diabetes mellitus diagnosis or decrease in treatment compliance and difficulties in obtaining medication cause an increase in hospitalizations due to diabetic ketoacidosis.

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1.)Anedda L, Bianchini L, Cuzzolin L, et al. What if COVID-19 affects the child: which weapons and how touse them. Eur Rev Med Pharmacol Sci. 2021;25:3325-37.
2.)Kaplan LJ, Kleinpell R, Maves RC, et al. Critical care clinician reports on Coronavirus Disease 2019: Results from a National Survey of 4,875 ICU providers. Crit Care Explor. 2020;2:e0125.
3.)Ghinai I, McPherson TD, Hunter JC, et al. First known person- to-person transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the USA. Lancet. 2020;395:1137-44.
4.)Ludvigsson JF. Systematic review of COVID 19 in children shows milder cases and a beter prognosis than adults. Acta Paediatr. 2020; 109: 1088 95.
5.)Dayal D. We urgently need guidelines for managing COVID 19 in children with comorbidities. Acta Paediatr. 2020; 109: 1497 98.
6.)Lazzerini M, Barbi E, Apicella A, et al. Delayed accessor provision of care in Italy resulting from fear of COVID-19. Lancet Child Adolesc Heal. 2020;4:e10–e11.
7.)Wilder JL, Parsons CR, Growdon AS, et al. Pediatric hospitalizations during the COVID-19 pandemic. Pediatr. 2020; 146:e2020005983.
8.)Graciano AL, Bhutta AT, Custer JW. Reduction in paediatric intensive care admissions during COVID-19 lockdown in Maryland, USA. BMJ Paediatrics Open. 2020;4:e000876.
9.)Chu DK, Akl EA, Duda S, et al. COVID-19 systematic urgent review group effort (SURGE) study authors. Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis. Lancet 2020;395:1973-87.
10.)Vásquez-Hoyos P, Diaz-Rubio F, Monteverde-Fernandez N, et al. Reduced PICU respiratory admissions during COVID-19. Arch Dis Child. 2020; archdischild-2020-320469.
11.)Lönnrot M, Lynch KF, Elding Larsson H, et al. Respiratory infections are temporally associated with initiation of type 1 diabetes autoimmunity: the TEDDY study. Diabetologia. 2017;60:1931– 40.
12.)Liu F, Long X, Zhang B, et al. ACE2 expression in pancreas may cause pancreatic damage after SARS-CoV-2 infection. Clin Gastroenterol Hepatol. 2020; 18: 2128-30.
13.)Hawkes CP, Willi SM. A trend towards an early increase in ketoacidosis at presentation of paediatric type 1 diabetes during the coronavirus-2019 pandemic. Diabet Med. 2021;38:e14461.
14.)Dayal D, Gupta S, Raithatha D, et al. Missing during COVID-19 lockdown: Children with onset of type 1 diabetes. Acta Paediatr. 2020; 109: 2144-46.
15.)Rubino F, Amiel SA, Zimmet P, et al. New-onset diabetes in Covid-19. N Engl J Med. 2020;383:789-90.
16.)Gupta R, Gupta J, Ammar H, Impact of COVID-19 on the out comes of gastrointestinal surgery. Clin J Gastroenterol. 2021;29: 1-15.
17.)Lin JA, Braun HJ, Schwab ME, et al. Pandemic recovery: Persistent disparities in access to elective surgical procedures. Ann Surg. 2021 3. doi: 10.1097/SLA.0000000000004848.