Department of Pediatrics, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India

Abstract

Objective. This prospective study was conducted to evaluate the role of hemoglobin level, as a risk factor for Lower Respiratory Tract Infections in children (LRTI). Methods. 100 children who came to the outpatient department for LRTI were included in the study. Age and sex-matched 100children, not having any respiratory illness, were taken as control. They were subjected to complete blood count (CBC) ,C-reactive protein estimation (CRP), Mantoux test, and X-ray chest. Peripheral smear, serum ferritin and serum iron binding capacity were done for all anemic children. Results. Radiological evidence of pneumonia was present in 63 children(63%).Hyper inflated lungs were seen in 27 (27%). Mantoux was positive in 22 children (22%) of study group and none among control group. CRP > 6mg/L was noted in 45 children (45%) of study group and 14 (14%) of control group. Seventy four of study group (74 %) and 33 of control group (33%) had anemia. Of the anemic children, 60(60%) had iron deficiency,10 (10%) chronic inflammation and 4 (4%) had hemolytic anemia. These values were 30(30%), 2(2%) and1(1%)respectively for control group. Low hemoglobin level due to whatever etiology, was a risk factor (p=0.000). Conclusion. Anemic children were 5.75 times more susceptible to LRTI compared to the control group. Prevention of anemia, due to whatever etiology, will reduce the incidence of LRTI

Keywords: Lower respiratory tract infection; Hemoglobin level

Lower respiratory tract infections (LRTI) include all infections of the lungs and the large airways below the larynx.[1] On an average, children below 5 years of age suffer about 5-6 episodes of LRTI per year.[2]

A child was considered anemic, if the hemoglobin (Hb) level was below 11g/dL.[3] Lower respiratory tract infections associated with anemia occur more commonly in children than in adults. But low hemoglobin level due to whatever etiology per se, as a risk factor for developing LRTI has not been fully evaluated. Hence this prospective study was conducted for assessing low hemoglobin level, as a risk factor for developing LRTI in children.

Material and Methods

This prospective study was conducted in 100 children who attended the out patient unit of Department of Pediatrics, Amrita Institute of Medical Sciences and Research Centre Kochi, during the period of one year from March 2003 to February 2004. Pneumonia was diagnosed by symptoms and clinical signs.[4] Children with the following criteria were exempted from this study: (i) Congenital malformations of chest wall; (ii) Having severe systemic illness; (iii) Protein Energy Malnutrition (PEM > Grade III as per Indian Academy of Pediatrics (IAP) classification .[5]

Weight and height were recorded for all children to assess the nutritional status. The following investigations were done in all cases: Complete Blood Count (CBC), C reactive protein estimation (CRP), Mantoux test and X-ray chest. Peripheral smear, serum ferritin and serum iron binding capacity were done in all anemic children.