Nutritional rickets and vitamin D deficiency--association with the outcomes of childhood very severe pneumonia: a prospective cohort study

Pediatr Pulmonol. 2009 Dec;44(12):1207-15. doi: 10.1002/ppul.21121.

Abstract

Background: The association of rickets and vitamin D deficiency (VDD) with pneumonia is well documented, but not with its outcomes.

Objectives: To investigate whether rickets and VDD predict the outcomes in very severe pneumonia (VSP).

Design: A prospective cohort study conducted at Al-Sabeen hospital in Sana'a, Yemen. A total of 152 children aged 2-59 months with WHO-defined VSP were enrolled, managed, and followed for up to 30 days. Treatment outcome was either successful or failure (antibiotic modification for clinical worsening, death, relapse after 10-day antibiotics, or development of complications). Serum vitamin D (25OHD) was measured in 79 cases. A concentration of <or=30 nmol/L defines VDD.

Main outcome measures: Association of rickets with treatment outcome; and VDD with the circulating neutrophils (PMNs), and oxygen saturation% (SpO(2)%), respectively.

Results: Treatment failure occurred in 24 (15.8%), all aged 2-12 months, and 21 (87.5%) were rachitic. Of the 79 subset, 29 had VDD of which 23 (79.3%) had rickets. Treatment failure was significantly higher in the rachitic compared to non-rachitic [20.6% (21/102) vs. 6% (3/50); OR 1.38 (95% CI 1.13-1.69), P = 0.031]. In multivariate regression, rickets significantly predict a reduced successful treatment compared with non-rachitic [79.4% (81/102) vs. 94% (47/50); Adjusted OR 0.41 (95% CI 0.20-0.85); P = 0.02]. VDD was strongly associated with reduced PMNs% [Mean (SD) 37 (17) vs. 47 (17); Adjusted OR 0.71 (95% CI 0.53-0.95), P = 0.02], and reduced SpO(2)% [Mean (SD) 85.9 (7.9) vs. 89.8 (7.1); OR 0.96 (95% CI 0.93-0.99), P = 0.021].

Conclusions: In VSP, rickets was significantly associated with treatment outcome and VDD significantly predict both reduced circulating PMNs, and Day-5 hypoxemia (SpO(2)%, <88%).

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Child, Preschool
  • Cohort Studies
  • Female
  • Humans
  • Infant
  • Male
  • Pneumonia / blood
  • Pneumonia / complications*
  • Pneumonia / drug therapy
  • Prospective Studies
  • Rickets / blood
  • Rickets / complications*
  • Severity of Illness Index
  • Treatment Outcome
  • Vitamin D / blood
  • Vitamin D Deficiency / blood
  • Vitamin D Deficiency / complications*

Substances

  • Vitamin D