Relationship between serum zinc levels and the burden of treatment in children with pneumonia

Authors

  • Qui P. La Department of Pediatrics, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
  • Dien T. Lu Department of Pediatrics, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
  • Son H. Le Department of Pediatrics, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam

DOI:

https://doi.org/10.18203/2349-3291.ijcp20242328

Keywords:

Children, Zinc, Pneumonia, Treatment

Abstract

Background: Pneumonia is a common childhood disease often requiring hospitalization, with the potential for rapid progression and complications, particularly in children under five years old. Zinc plays a crucial role in various organ systems, especially the respiratory system. However, data on zinc levels and pneumonia in Vietnamese children remain limited. This study aimed to investigate the relationship between serum zinc levels and the treatment burden in children with pneumonia.

Methods: A prospective observational study was conducted involving 200 children aged 2 to 59 months who were diagnosed with pneumonia and hospitalized at Can Tho Children's Hospital, Vietnam. Serum zinc levels were measured, and treatment characteristics were monitored, including the need for respiratory support, antibiotic escalation, and treatment duration. Data were analyzed using descriptive statistics, independent t-tests, simple linear regression and multivariable linear regression to determine associations between serum zinc levels and treatment outcomes.

Results: Children who were not exclusively breastfed for the first six months had significantly lower serum zinc levels compared to those who were exclusively breastfed (p<0.001). Lower serum zinc levels were significantly associated with the need for respiratory support (p=0.001), antibiotic escalation (p=0.002), prolonged antibiotic use (p=0.01), and longer treatment duration (p=0.011). Multivariate linear regression revealed that each unit decrease in serum zinc levels increased treatment duration by 0.218 days (p=0.015).

Conclusion: Low serum zinc levels are associated with increased treatment burden in children under five years old with pneumonia.

References

Kelly MS, Sandora TJ. Community-acquired pneumonia. In: Kliegman RM, Geme III JW, eds. Nelson Textbook of Pediatrics. Philadelphia. Elsevier; 2024: 2642-51.

UNICEF. Pneumonia in Children Statistics. Available at: data.unicef.org/topic/child-health. Accessed on 20 June 2024.

Skalny AV, Rink L, Ajsuvakova OP, Aschner M, Gritsenko VA, Alekseenko SI, et al. Zinc and respiratory tract infections: perspectives for COVID-19. Int J Mol Med. 2020;46(1):17-26.

Gammoh NZ, Rink L, Mahmoudi M, Rezaei N. Zinc and the immune system, nutrition and immunity. Switzerland, Springer Nature. 2019:127-58.

Gammoh NZ, Rink L. Zinc in infection and inflammation. Nutrients. 2017;9(6):624.

Lassi ZS, Moin A, Bhutta ZA. Zinc supplementation for the prevention of pneumonia in children aged 2 months to 59 months. Cochrane Database Syst Rev. 2016;12(12):5978.

7. Assar EH, Hassaneen BE, Ismael YM, Ibrahim AA. The relationship of serum zinc level in patients with pneumonia and its effect on their outcome. Egypt J Hosp Med. 2024;95(1): 2195-220.

8. Saleh NY, Abo El Fotoh WMM. Low serum zinc level: The relationship with severe pneumonia and survival in critically ill children. Int J Clin Pract. 2018;72(6):13211.

Hamed AMM, Kassem YT, Fayed HK, Solaiman AM. Serum zinc levels in hospitalized children with pneumonia: a hospital-based case–control study. Egypt J Bronchol. 2019;13(5):730-7.

WHO. Pneumonia in children. Available at: www.who.int/news-room/fact-sheets. Accessed on 24 December 2022.

Scotta MC, Marostica PJC, Stein RT. Pneumonia in children, Kendig’s disorders of the respiratory tract in children. Philadelphia. Elsevier. 2019:427-38.

WHO Exclusive breastfeeding for optimal growth, development and health of infants. Available at: www.who.int/tools/elena/interventions/exclusive-breastfeeding. Accessed on 24 April 2024.

Ministry of Health. Expanded vaccination indicators in Vietnam. Hanoi, Ministry of Health. 2024.

Wang X, Long Y, Su L, Zhang Q, Shan G, He H. Using procalcitonin to guide antibiotic escalation in patients with suspected bacterial infection: a new application of procalcitonin in the intensive care unit. Front Cell Infect Microbiol. 2022;12:844134.

Rajasekaran J, Geminiganesan S, Jayapalan DK, Padmanaban R. Serum zinc levels in children 1-59 months of age with pneumonia: a single-center surveillance in India from 2014 to 2016. Arch Pediatr Infect Dis. 2020;8(2):98735.

Hussain AM, Saldanha P, Sharma DK, Pandita A. Estimation of zinc levels in children with lower respiratory tract infections: a prospective observational study from India. Pediatr Neonatal Nurs Open J. 2016;2(3):91-8.

Marcos J, Perlas L, Gironella GM. Risk factors associated with zinc status of Filipino preschool and school-aged children. Philipp J Sci. 2020;148(2): 225-36.

Kumar N, Jayaprakash S, Kavitha D. Low serum zinc level- a possible marker of severe pneumonia. J Med Sci Clin Res. 2017;5(5):21554-70.

Rios-Leyvraz M, Yao Q. Calcium, zinc, and vitamin D in breast milk: a systematic review and meta-analysis. Int Breastfeed J. 2023;18(1):27.

Maywald M, Rink L, Fukada T, Kambe T. Zinc signals in immunology. Zinc Signaling. 2nd ed. Singapore, Springer. 2019:243-77.

Brooks WA, Yunus M, Santosham M, Wahed MA, Nahar K, Yeasmin S, et al. Zinc for severe pneumonia in very young children: double-blind placebo-controlled trial. Lancet. 2004;363(9422): 1683-8.

Khera D, Singh S, Purohit P, Sharma P, Singh K. Prevalence of zinc deficiency and the effect of zinc supplementation on the prevention of acute respiratory infections. Turk Thorac J. 2020;21(6): 371-6.

Bothe MK, Mundhenk L, Kaup M, Weise C, Gruber AD. The murine goblet cell protein mCLCA3 is a zinc-dependent metalloprotease with autoproteolytic activity. Mol Cells. 2011;32(6): 535-41.

Hussain A, Jiang W, Wang X, Shahid S, Saba N, Ahmad M, et al. Mechanistic impact of zinc deficiency in human development. Front Nutr. 2022;9:717064.

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Published

2024-08-27

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Original Research Articles