title: Nutritional rickets and vitamin D deficiency--association with the outcomes of childhood very severe pneumonia: a prospective cohort study.
abstract: BACKGROUND
  The association of rickets and vitamin D deficiency (VDD) with pneumonia is well documented, but not with its outcomes.
  
  
  OBJECTIVE
  To investigate whether rickets and VDD predict the outcomes in very severe pneumonia (VSP).
  
  
  METHODS
  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.
  
  
  METHODS
  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%).
authors.affiliation: Sana'a University, Sana'a, Yemen. sbanaj@yemen.net.ye
authors.forename: Salem M
authors.initials: SM
authors.lastname: Banajeh
mesh_terms: D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D011014:Pneumonia / Q000097:blood / Q000150:complications* / Q000188:drug therapy; D011446:Prospective Studies; D012279:Rickets / Q000097:blood / Q000150:complications*; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014807:Vitamin D / Q000097:blood; D014808:Vitamin D Deficiency / Q000097:blood / Q000150:complications*
chemical_list: D014807:Vitamin D