Nutritional Rickets and Vitamin D Deficiency-Association With the Outcomes of Childhood Very Severe Pneumonia: A Prospective Cohort Study

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 <= 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 % Cl 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 % Cl 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 % Cl 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 % Cl 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 %). Pediatr Pulmonol. 2009; 44:1207-1215. (C) 2009 Wiley-Liss, Inc.