Background and Objectives: The incidence of severe and moderate forms of DKA as the initial presentation of type 1 diabetes mellitus (T1D) is increasing, especially during the COVID-19 pandemic. This poses a higher risk of developing cerebral edema as a complication of diabetic ketoacidosis (DKA), as well as morbidity and mortality rates. The aim of this study was to determine the trend and clinical features of children treated in the last 10 years in the Pediatric Intensive Care Unit (PICU) due to the development of DKA. Materials and Methods: This retrospective study was performed in the PICU, Clinical Hospital Centre Rijeka, in Croatia. All children diagnosed with DKA from 2011–2020 were included in this study. Data were received from hospital medical documentation and patient paper history. The number of new cases and severity of DKA were identified and classified using recent International Society for Pediatric and Adolescent Diabetes (ISPAD) guidelines. Results: In this investigation period, 194 children with newly diagnosed T1D were admitted to our hospital: 58 of them were treated in the PICU due to DKA; 48 had newly diagnosed T1D (48/58); and ten previously diagnosed T1D (10/58). DKA as the initial presentation of T1D was diagnosed in 24.7% (48/194). Moderate or severe dehydration was present in 76% of the children at hospital admission. Polyuria, polydipsia, and Kussmaul breathing were the most common signs. Three patients (5.2%) developed cerebral edema, of whom one died. Conclusions: During the investigation period a rising trend in T1D was noted, especially in 2020. About one quarter of children with T1D presented with DKA at initial diagnosis in western Croatia, most of them with a severe form. Good education of the general population, along with the patients and families of children with diabetes, is crucial to prevent the development of DKA and thus reduce severe complications.

SNAP and 5-min Apgar scores are important outcome indicators, can aid clinicians' and parents' decision making on the benefits and burdens of acute medical interventions and help determine quantities of medical treatment. Educated medical staff, effective and efficient medical treatment and a high quality of care which prevent adverse events in the first minute of life should be a priority in efforts to improve the future quality of life.

Acute respiratory distress syndrome (ARDS) is a condition recognised for almost fifty years, and is related to high morbidity and mortality in children. From its recognition, medical experts tried to make joint efforts to make recommendations and optimize treatment in children and adult population. The new definition of ARDS suggests treatment by introducing three levels of severity, according to PaO2/ FiO2 and positive end-expiratory pressure. Lung-protective ventilation remains crucial in achieving better outcome in paediatric acute respiratory distress syndrome (PARDS), but promising therapies based on paediatric studies include non-invasive ventilation, endotracheal surfactant, highfrequency oscillatory ventilation (HFOV), and use of ECMO as "rescue" therapy. Nevertheless, PARDS is a real challenge for the paediatric critical care provider, and even if current state-of-the-art treatment methods are delivered, this disease often leads to fatal outcome. We report the case of an 11-month-old female infant who developed ARDS, was treated by current up-to-date treatment methods, including ECMO, and despite this, succumbed to her illness. With this case report we would like once more to bring to consideration the current knowledge on etiology, epidemiology, diagnosis and treatment of ARDS in children, and emphasize the high morbidity and mortality related to this syndrome.

Cilj: Cilj istraživanja bio je utvrditi pojavnost, kliničke karakteristike te ishod prijevremeno rođene dojenčadi, liječene na Odjelu intenzivnog liječenja djece Klinike za pedijatriju Kliničkog bolničkog centra Rijeka, u razdoblju 2014. – 2018. godine. Ispitanici i metode: Ispitanici su sva prijevremeno rođena dojenčad liječena na Odjelu intenzivnog liječenja djece Klinike za pedijatriju Kliničkog bolničkog centra Rijeka, u razdoblju 2014.-2018. Ispitanici su prema gestacijskoj dobi podijeljeni u četiri skupine (ekstremno prijevremeno rođena, vrlo prijevremeno rođena, umjereno prijevremeno rođena, kasno prijevremeno rođena djeca) te su navedene skupine uspoređivane s obzirom na pojedine kliničke karakteristike. Rezultati: Ispitivanje je obuhvatilo ukupno 176-ero prijevremeno rođene dojenčadi. U skupini ispitane ekstremno prijevremeno rođene dojenčadi razlozi hospitalizacija u 90,3 % slučajeva bile su komplikacije prijevremenog rođenja, u skupini vrlo prijevremeno rođene dojenčadi komplikacije prijevremenog rođenja bile su razlogom hospitalizacija u 62,1 %, u 35 % slučajeva dojenčadi umjerenog, a u skupini dojenčadi kasnog prijevremenog rođenja 22,4 %. Od ukupnog broja ispitivane prijevremeno rođene dojenčadi, njih 79 (44,9 %) imalo je 1-2 komplikacije, 35 (19,9 %) ih je imalo 3-4 komplikacije, a 15-ero (8,5 %) prematurne dojenčadi imalo je pet ili više komplikacija prijevremenog rođenja. Od ukupno 176-ero ispitivane prijevremeno rođene dojenčadi u navedenom periodu, 14-ero (8 %) ih je umrlo tijekom hospitalizacije. Zaključci: Budući da su prema literaturi najčešći razlozi hospitalizacija prijevremeno rođene dojenčadi infekcije, nerijetko izravno povezane s komplikacijama prijevremenog rođenja, pokušaji smanjenja navedenog broja hospitalizacija trebali bi biti usmjereni upravo prema smanjenju broja infekcija. Uz navedeno bi, vjerojatno, poželjan učinak imala i dodatna koordinacija skrbi i praćenja.