Assessment of Bone Metabolism In Children Below Two Years of Age Diagnosed With Pneumonia At Kenyatta National Hospital

Introduction 

Pneumonia, an acute lower respiratory tract infection is a leading cause of morbidity and mortality globally. The determinants of poor outcomes in pneumonia include poor nutrition. Bone metabolism disorders such as rickets have been reported to have a negative impact on treatment and prognosis of pneumonia.  Rickets increases the risk of pneumonia by compromising expansion of the chest cavity and impairing the ability of the lungs to fight off infections. Serum calcium, phosphorus, alkaline phosphatase (ALP) levels and 1,25(OH)Vitamin D3 (Vitamin D) are markers mostly used in diagnosis of rickets.

Methodology

A retrospective cross-sectional study was carried out at the Health Information Department at KNH on files submitted from the Pediatrics wards for archiving on children admitted with pneumonia between June and December, 2024. Data abstracted included, age, gender, dates of admissions and discharge, biochemistry laboratory results of the bone metabolism markers. The laboratory results were analysed using the reference ranges used at the KNH Biochemistry laboratory.

Results 

The study included 120 children all diagnosed with pneumonia between June and December 2024. Data analysis indicated a marked increase in frequency of vitamin D abnormalities with low vitamin D levels having a point prevalence of 61.2%. The prevalences of hypocalcemia, hypophosphatemia and high ALP levels were, 34.16%, 12.5%, and 10.83% respectively. The average length of hospital stay (LOHS) was calculated at 23 days with the longest hospital stay being 209 days and the least being 1 day. There was a weak statistical significance between hypocalcemia and increased LOHS p-value 0.04 OR 2.475 CI 95% 2.365,2.59).

Conclusion

The prevalence of hypocalcemia was higher among female children (40%) compared to males (27.27%). There was no significant difference in serum phosphorus, ALP and vitamin D abnormalities between males and females.
There was a weak significant relationship between calcium and the length of hospital stay (OR 2.475 (CI 95% 2.365,2.590). The other bone chemistry markers did not show any statistical significance with the length of hospital stay.