Viral infections in the pediatric ICU: Endemic vs pandemic corona virus impact: A tertiary care center experience

Objectives: To measure the prevalence of viral infections, length of stay (LOS), and outcome in children admitted to the pediatric intensive care unit (PICU) during the period preceding the COVID-19 pandemic in a MERS-CoV endemic country.

Methods: A retrospective chart review of children 0–14 years old admitted to PICU with a viral infection.

Results: Of 1736 patients, 164 patients (9.45%) had a positive viral infection. The annual prevalence trended downward over a three-year period, from 11.7% to 7.3%. The median PICU LOS was 11.6 days. Viral infections were responsible for 1904.4 (21.94%) PICU patient-days. Mechanical ventilation was used in 91.5% of patients, including noninvasive and invasive modes. Comorbidities were significantly associated with intubation (P-value =0.025). Patients infected with multiple viruses had median pediatric index of mortality 2 (PIM 2) scores of 4, as compared to 1 for patients with single virus infections virus infections (p <0.001), and a median PICU LOS of 12 days, compared to 4 in the single-virus group (p <0.001). Overall, mortality associated with viral infections in PICU was 7 (4.3%). Patients with viral infections having multiple organ failure were significantly more likely to die in the PICU (p =0.001).

Conclusion: Viral infections are responsible for one-fifth of PICU patient-days, with a high demand for mechanical ventilation. Patients with multiple viral infections had longer LOS, and higher PIM 2 scores. The downward trend in the yearly rate of PICU admissions for viral infections between the end of the MERS-CoV outbreak and the start of the COVID-19 pandemic may suggest viral interference that warrants further investigations.

Prof Gamal Ahmed is a professor of Pediatrics and consultant pediatric critical care. He has an extensive experience in the field of pediatric critical care with special interest in the area of critical infections and sepsis. He has an extensive academic as well as clinical practice experience in Egypt, Saudi Arabia, and United Arab Emirates. He has multiple numerous publications at international peer reviewed journals. He is reviewer at many international pediatric journals. He has special interest in the field of medical education and currently, pediatric residency program director at Sheikh Shakhbout Medical City, Abu Dhabi, UAE.