Department of Pediatrics, Pandit Bhagwat Dayal Sharma Post-Graduate Institute of Medical Sciences, Rohtak, India.
Department of Pediatrics, Pandit Bhagwat Dayal Sharma Post-Graduate Institute of Medical Sciences, Rohtak, India -
Minerva Pediatr (Torino). 2024 Apr;76(2):227-235. doi: 10.23736/S2724-5276.21.06036-9. Epub 2021 Apr 12.
International and observational epidemiological studies provide evidence that vitamin D deficiency may confer increased risk of influenza and respiratory tract infection. This study was undertaken to evaluate the prevalence of vitamin D deficiency in pneumonia in children, and to assess its relationship with the severity.
Study group included children aged between 2 months to 5 years of age admitted as inpatients who presented with clinical features of pneumonia as per WHO Classification. Detailed clinical assessment and physical examination was done at the time of admission and patients were enrolled and relevant findings were noted in prestructured proforma. Vitamin D levels <30 nmol/L (<12 ng/mL) were defined as deficient, 30-50 nmol/L (12-20 ng/mL) as insufficient, and >125 nmol/L (>50 ng/mL) as sufficient. Outcomes of the patients admitted were recorded in terms of duration of hospitalization, Intensive Care Unit (ICU) stay, oxygen requirement, antibiotic need and duration, need for upgradation of antibiotics, nebulization need with drugs used, ventilator need and other parameters. Statistical analysis was performed using statistical package for social sciences software (SPSS Inc., Chicago, IL, USA). A P value of <0.05 was considered statistically significant.
Out of 101 patients, 100% presented with fever, cough and fast breathing, 42.6% with grunting, 41 (40.5%) with noisy breathing, 5.7% with bluish discoloration, and 4.3% with apnea. Forty-one (40.5%) patients had crepitation, 53 (52.4%) patients had rhonchi, while 7 (6%) presented with bronchial breathing. Chest radiography features at admission helped to differentiate between presumed viral and presumed bacterial infection. Vitamin D deficient patients had significantly longer duration of hospital stay as compared to vitamin D sufficient group (P<0.001). The need for upgradation of antibiotics between the three groups were found to be significant (P<0.001). This showed that vitamin D deficiency is directly proportional to the need of upgradation of antibiotics. Bacterial pneumonia presents mostly as alveolar infiltrates and/or pleural effusion while viral pneumonia presents as interstitial infiltrates and/or hyperinflation. Cases with presumed bacterial pneumonia (based on X-ray, 38 out of 48, 79.1%) were more often vitamin D deficient as compared to case with presumed viral pneumonia (32 out of 52, 61.5%, P=0.05).
Vitamin D is widely prevalent in Indian children with pneumonia. Vitamin D deficient patients needed a longer duration of hospitalization, more upgradation of antibiotics, and PICU admissions; moreover, it had more CPAP requirement, longer duration of PICU stay and longer duration of CPAP requirements as compared to vitamin D sufficient group.
国际和观察性流行病学研究表明，维生素 D 缺乏可能会增加流感和呼吸道感染的风险。本研究旨在评估儿童肺炎中维生素 D 缺乏的患病率，并评估其与严重程度的关系。
研究组纳入了年龄在 2 个月至 5 岁之间的住院患儿，这些患儿均符合世界卫生组织分类的肺炎临床特征。在入院时进行详细的临床评估和体格检查，并在预构表中记录患者的入组情况和相关发现。维生素 D 水平<30 nmol/L（<12 ng/mL）定义为缺乏，30-50 nmol/L（12-20 ng/mL）为不足，>125 nmol/L（>50 ng/mL）为充足。记录入院患儿的住院时间、重症监护病房（ICU）入住时间、氧需求、抗生素需求和持续时间、抗生素升级需求、药物雾化需求、呼吸机需求和其他参数等治疗结局。采用社会科学统计软件包（SPSS Inc.，芝加哥，IL，USA）进行统计学分析。P 值<0.05 被认为具有统计学意义。
在 101 例患儿中，100%出现发热、咳嗽和呼吸急促，42.6%出现呼噜声，41 例（40.5%）出现喘鸣，5.7%出现发绀，4.3%出现呼吸暂停。41 例（40.5%）患儿出现湿啰音，53 例（52.4%）患儿出现干啰音，7 例（6%）患儿出现支气管呼吸音。入院时的胸部 X 线特征有助于区分疑似病毒性和疑似细菌性感染。与维生素 D 充足组相比，维生素 D 缺乏组患儿的住院时间明显更长（P<0.001）。三组间抗生素升级的需求差异有统计学意义（P<0.001）。这表明维生素 D 缺乏与抗生素升级的需求呈正相关。细菌性肺炎主要表现为肺泡浸润和/或胸腔积液，而病毒性肺炎主要表现为间质性浸润和/或过度充气。基于 X 线检查，细菌性肺炎（48 例中有 38 例，79.1%）患儿中维生素 D 缺乏的比例高于病毒性肺炎（52 例中有 32 例，61.5%，P=0.05）。
维生素 D 在印度肺炎患儿中普遍存在。维生素 D 缺乏患儿需要更长的住院时间、更多的抗生素升级以及需要进入儿科重症监护病房；此外，与维生素 D 充足组相比，维生素 D 缺乏患儿需要更多的 CPAP 支持，更长的儿科重症监护病房住院时间和 CPAP 需求时间。
