Int J Clin Pediatr

International Journal of Clinical Pediatrics, ISSN 1927-1255 print, 1927-1263 online, Open Access

Article copyright, the authors; Journal compilation copyright, Int J Clin Pediatr and Elmer Press Inc

Journal website http://www.theijcp.org

Original Article

Volume 5, Number 2, June 2016, pages 19-28

Clinical Presentation of Malnourished Patients With Pneumonia Requiring Prolonged Ventilatory Support

Figure 2. Cutoffs of z scores definitions of normal versus undernutrition, wasting and stunting according to WHO/NCHS.

Figure 3. (A) Hemoglobin and plasma proteins at time of admission. (B) Plasma copper at time of admission. (C) Plasma ceruloplasmin at time of admission.

Figure 4. Odds ratios and exact 95% confidence intervals of associations between measures of malnutrition and death, other illness and recurrent infection. For duration of ventilation, the ratios of geometric means with 95% confidence intervals are given.

Figure 5. Plasma proteins after exposure to oxygen in GI. The observations are represented by circles, which are connected if they belong to the same patient. A fitting line represents the trend.

**Table 1.** Subjects’ Clinical Characteristics at Time of Admission
	G1 (N = 38)	G2 (N = 19)	C (N = 18)
^†Difference between G1 and G2 significant at alpha = 0.05. *Difference between G1 and C significant at alpha = 0.05. ^¶Difference between G2 and C significant at alpha = 0.05. §One missing observation. Values are mean ± SD, number of subjects with percent in parentheses.
Age (months)*^¶	9.6 ± 10.9	5.2 ± 4.6	17.1 ± 9.6
Weight (kg)*^¶	6.2 ± 3.4	5.8 ± 2.1	9.9 ± 2.3
Height/length (cm)*^¶	63.5 ± 11.6	60.2 ± 9.1	77.4 ± 9.0
ZWA*^¶	-2.1 ± 2.0	-1.5 ± 1.5	-0.2 ± 1.2
ZHA*	-1.9 ± 1.9	-1.6 ± 2.3	-0.3 ± 1.1
ZWH*	-1.3 ± 2.1	-0.2 ± 2.3	-0.0 ± 1.1
Male gender	21 (55.3)	9 (47.4)	7 (38.9)
Low birth weight	7 (18.4)	2 (10.5)	0 (0.0)
Feeding practice after birth: breastfed (± supplementation)*	23 (60.5)	16 (84.2)	18 (100.0)
Formula only	15 (39.5)	3 (15.8)	0 (0.0)
Previously hospitalized	8 (21.1)	2 (10.5)
First episode	26 (68.4)	15 (78.9)
Recurrent infection	12 (31.6)	4 (21.1)
Severity of RD^†
II	7 (18.4)	13 (68.4)
III	26 (68.4)	6 (31.6)
IV	5 (13.2)	0
Route of feeding^†		§
IV	14 (36.8)	9 (50.0)
NG	1 (2.6)	8 (44.4)
Both	23 (60.5)	1 (5.6)
Vomiting^†	6 (15.8)	9 (47.4)
Diarrhea	5 (13.2)	7 (36.8)
Fever	34 (89.5)	14 (73.7)

Table 1. Subjects’ Clinical Characteristics at Time of Admission

G1 (N = 38)

G2 (N = 19)

C (N = 18)

^†Difference between G1 and G2 significant at alpha = 0.05. *Difference between G1 and C significant at alpha = 0.05. ^¶Difference between G2 and C significant at alpha = 0.05. §One missing observation. Values are mean ± SD, number of subjects with percent in parentheses.

Age (months)*^¶

9.6 ± 10.9

5.2 ± 4.6

17.1 ± 9.6

Weight (kg)*^¶

6.2 ± 3.4

5.8 ± 2.1

9.9 ± 2.3

Height/length (cm)*^¶

63.5 ± 11.6

60.2 ± 9.1

77.4 ± 9.0

ZWA*^¶

-2.1 ± 2.0

-1.5 ± 1.5

-0.2 ± 1.2

ZHA*

-1.9 ± 1.9

-1.6 ± 2.3

-0.3 ± 1.1

ZWH*

-1.3 ± 2.1

-0.2 ± 2.3

-0.0 ± 1.1

Male gender

21 (55.3)

9 (47.4)

7 (38.9)

Low birth weight

7 (18.4)

2 (10.5)

0 (0.0)

Feeding practice after birth: breastfed (± supplementation)*

23 (60.5)

16 (84.2)

18 (100.0)

Formula only

15 (39.5)

3 (15.8)

0 (0.0)

Previously hospitalized

8 (21.1)

2 (10.5)

First episode

26 (68.4)

15 (78.9)

Recurrent infection

12 (31.6)

4 (21.1)

Severity of RD^†

7 (18.4)

13 (68.4)

III

26 (68.4)

6 (31.6)

5 (13.2)

Route of feeding^†

14 (36.8)

9 (50.0)

1 (2.6)

8 (44.4)

Both

23 (60.5)

1 (5.6)

Vomiting^†

6 (15.8)

9 (47.4)

Diarrhea

5 (13.2)

7 (36.8)

Fever

34 (89.5)

14 (73.7)

**Table 2.** Association Between Malnutrition and Pneumonia Morbidity (All Patients)
	Died*	Other illness	Recurrent infection	Duration of ventilation (h)**
Death status is missing for one patient, so only 56 patients are included. Duration of ventilation is reported as geometric means with 95% confidence intervals within groups, comparison between groups by ratio of geometric means. **Statistically significant associations.
Low weight for age
Yes	3/26 (12%)	8/26 (31%)	11/26 (42%)***	143 (97 - 211)***
No	6/30 (20%)	10/31 (32%)	5/31 (16%)***	90 (68 - 119)***
OR (95% CI)	0.52 (0.08 - 2.83)	0.93 (0.26 - 3.30)	3.81 (0.97 - 16.47) ***	1.59 (1.02 - 2.50)***
Exact P-value	0.48	1.00	0.040***	0.043***
Low height for age
Yes	2/20 (10%)	11/20 (55%)***	11/20 (55%)***	126 (81 - 197)
No	7/36 (19%)	7/37 (19%)***	5/37 (14%)***	102 (77 - 235)
OR (95% CI)	0.46 (0.04 - 2.83)	5.24 (1.35 - 20.82) ***	7.82 (1.84 - 35.47)***	1.24 (0.77 - 2.01)
Exact P-value	0.47	0.0077***	0.0016***	0.37
Low weight for height
Yes	4/19 (21%)	6/19 (32%)	8/19 (42%)	142 (91- 222)
No	5/37 (14%)	12/38 (32%)	8/38 (21%)	94 (72 - 123)
OR (95% CI)	1.71 (0.29 - 9.17)	1.00 (0.25 - 3.74)	2.73 (0.69-10.62)	1.51 (0.95 - 2.40)
Exact P-value	0.47	1.00	0.12	0.08
Low birth weight
Yes	4/9 (44%)***	4/9 (44%)	3/9 (33%)	132 (49 - 356)
No	5/47 (11%)***	14/48 (29%)	13/48 (27%)	107 (85 - 134)
OR (95% CI)	6.72 (0.95 - 43.48)***	1.94 (0.33 - 10.46)	1.35 (0.19 - 7.46)	1.24 (0.67 - 2.27)
Exact P-value	0.029***	0.44	0.7	0.63

Table 2. Association Between Malnutrition and Pneumonia Morbidity (All Patients)

Died*

Other illness

Recurrent infection

Duration of ventilation (h)**

*Death status is missing for one patient, so only 56 patients are included. **Duration of ventilation is reported as geometric means with 95% confidence intervals within groups, comparison between groups by ratio of geometric means. ***Statistically significant associations.

Low weight for age

Yes

3/26 (12%)

8/26 (31%)

11/26 (42%)***

143 (97 - 211)***

6/30 (20%)

10/31 (32%)

5/31 (16%)***

90 (68 - 119)***

OR (95% CI)

0.52 (0.08 - 2.83)

0.93 (0.26 - 3.30)

3.81 (0.97 - 16.47) ***

1.59 (1.02 - 2.50)***

Exact P-value

0.48

1.00

0.040***

0.043***

Low height for age

Yes

2/20 (10%)

11/20 (55%)***

126 (81 - 197)

7/36 (19%)

7/37 (19%)***

5/37 (14%)***

102 (77 - 235)

OR (95% CI)

0.46 (0.04 - 2.83)

5.24 (1.35 - 20.82) ***

7.82 (1.84 - 35.47)***

1.24 (0.77 - 2.01)

Exact P-value

0.47

0.0077***

0.0016***

0.37

Low weight for height

Yes

4/19 (21%)

6/19 (32%)

8/19 (42%)

142 (91- 222)

5/37 (14%)

12/38 (32%)

8/38 (21%)

94 (72 - 123)

OR (95% CI)

1.71 (0.29 - 9.17)

1.00 (0.25 - 3.74)

2.73 (0.69-10.62)

1.51 (0.95 - 2.40)

Exact P-value

0.47

1.00

0.12

0.08

Low birth weight

Yes

4/9 (44%)***

4/9 (44%)

3/9 (33%)

132 (49 - 356)

5/47 (11%)***

14/48 (29%)

13/48 (27%)

107 (85 - 134)

OR (95% CI)

6.72 (0.95 - 43.48)***

1.94 (0.33 - 10.46)

1.35 (0.19 - 7.46)

1.24 (0.67 - 2.27)

Exact P-value

0.029***

0.44

0.7

0.63

**Table 3.** Arterial Blood Gas Measures in Patients
	G1	G2
^†Significant difference between G1 and G2 at alpha = 0.05.
HCO₃^†	28.9 (25.7 - 32.0)	6.4	19.6 (16.9 - 22.4)	5.4
FIO₂	51.5 (41.2 - 61.7)	14.8
PaO₂	73.1 (53.0 - 93.1)	40.8	61.4 (49.6 - 73.1)	22.9
PaO₂/FIO₂	184.7 (102.1 - 267.3)	125.5
PaCO₂^†	44.3 (38.7 - 49.9)	11.2	31.2 (26.7 - 35.7)	8.8

Table 3. Arterial Blood Gas Measures in Patients

Mean (95% CI)

^†Significant difference between G1 and G2 at alpha = 0.05.

HCO₃^†

28.9 (25.7 - 32.0)

6.4

19.6 (16.9 - 22.4)

5.4

FIO₂

51.5 (41.2 - 61.7)

14.8

PaO₂

73.1 (53.0 - 93.1)

40.8

61.4 (49.6 - 73.1)

22.9

PaO₂/FIO₂

184.7 (102.1 - 267.3)

125.5

PaCO₂^†

44.3 (38.7 - 49.9)

11.2

31.2 (26.7 - 35.7)

8.8