Title: Low Serum Zinc Level- a Possible Marker of Severe Pneumonia
Authors: Dr N. Kumar, MD, Dr S. Jayaprakash, MD, Dr D. Kavitha, MD
DOI: https://dx.doi.org/10.18535/jmscr/v5i5.53
Abstract
Pneumonia is one of the main causes of death in under five children1. Zinc deficiency is associated and may lead to the cause of pneumonia. In our region we have no data about serum zinc levels in under five children and in the hospitalized children with pneumonia. Aim of the study is to compare the serum zinc levels among children 6 months to 60 months of age hospitalized with severe pneumonia with the same age matched controls. This could give us an idea about the necessary for zinc supplementation in under five children and also the need for serum zinc level estimation in children with severe pneumonia as a routine investigation in pneumonia management. This is a case control study conducted at the department of pediatrics, Coimbatore Medical College Hospital from July 2014-June2015. All hospitalized children 6 to 60 months of age with severe pneumonia (both bronchopneumonia and lobar pneumonia) as per WHO criteria, with x-ray finding are selected. Children with clinical features of congenital zinc deficiency, PEM grade III and IV, immunodeficiency, ADD, hospital acquired pneumonia; on zinc containing supplements were excluded. Age matched healthy controls included for comparison. Children with clinical features of congenital zinc deficiency, PEM grade III and IV, on zinc containing supplemental were excluded in control group. 50 cases and 50 controls are included for study. Serum zinc levels are estimated using atomic absorption spectrometry and compared. All children were from lower socioeconomic class. Zinc level – “cut off value taken as “For males and females less than 10 years in South Asian population is 65Kg/dl. All data were analyzed with a statistical software package (SPSS, version 16.0 for windows)”. About 80% of children with severe pneumonia had low serum zinc levels (P= 0.001). Slight preponderance of male is seen in the study group (p>0.5). No association between low serum zinc level and variables like age, sex, place of residence, duration of breast feeding, time of weaning, preterm/twin pregnancy, calorie and protein gap, developmental milestones, immunization history and family history of seizures were noted. There was strong association between low serum zinc level and mixed feeds. So exclusive breast feeding seems to be protective against zinc deficiency. Low birth weight has strong association with low serum zinc level. Low serum zinc levels have significant association with febrile seizures. Increased frequency of illness in past 6 months is associated with low serum zinc levels. Strong association of low serum zinc levels with vegetarian diet. Non vegetarian diet is protective against zinc deficiency. As 68% of study population is less than 2 years of age, intake of tubers does not have significant association with low serum zinc level. In this study low serum zinc is associated with tachypnea, increased respiratory distress and low oxygen saturation. Low serum zinc level is associated with leucocytosis significantly and this may be due to increased susceptibility to infection. Low serum zinc level does not have significant association with type of pneumonia that is lobar pneumonia or bronchopneumonia. There is no association between low serum zinc level and hospital stay. In conclusion, children with severe pneumonia have low serum zinc levels and thus “Low serum zinc level is a marker of severe pneumonia. Also lower the serum zinc level the higher the respiratory distress and associated significantly with low oxygen saturation.
Keywords: Serum, Zinc level, severe pneumonia
