ESPE Abstracts

Background: Hypoxic-ischemic encephalopathy (HIE) after return of spontaneous circulation (ROSC) following cardiac arrest can sometimes be complicated by central diabetes insipidus (CDI). However, studies on the clinical course of CDI in children are limited.

Objective: This study aims to investigate the time and conditions required for the onset and diagnosis of CDI in children with HIE after ROSC.

Methods: We retrospectively analyzed children under 18 years old who were admitted to our hospital after achieving ROSC following cardiac arrest over the past ten years since April 2014. Among these, patients newly diagnosed with HIE and subsequently developed CDI (CDI group) were included. We examined the duration from the onset of polyuria and hypernatremia to the dependency on vasopressin (AVP) and the duration until the diagnosis of CDI. Additionally, we compared the age and low flow time between the CDI group and children who developed HIE without CDI (non-CDI group).

Results: The CDI group consisted of cases with a median age (interquartile range: IQR) of 6 (4, 10) years. The median (IQR) low flow time, days until AVP dependency, and days until CDI diagnosis were 55 (43, 63) minutes, 1 (1, 3) day, and 11(9, 15) days, respectively. The non-CDI group included 19 cases with a median age (IQR) of 1 (0, 4) years and a median low flow time (IQR) of 28 (21.5, 60.5) minutes. The comparison revealed a significantly higher age in the CDI group (P = 0.032), while the low flow time showed no significant difference (P = 0.21).

Discussion: In adults, most cases of CDI are diagnosed within seven days of developing HIE post-cardiac arrest. In contrast, children in this study became AVP-dependent within 7 days. Early CDI diagnosis is complicated by the variability in testing times and items, along with the rapid response to electrolyte abnormalities and polyuria in the ICU setting. This suggests a higher susceptibility to CDI in older children, though further accumulation of cases is necessary for confirmation.

Conclusion: Children with HIE after ROSC tend to develop CDI within a week, with a higher likelihood in older children. Further studies with larger sample sizes are needed to validate these findings.