IMPACT OF OBESITY IN CHILDREN WITH ACQUIRED PNEUMONIA FROM THE COMMUNITY

Abstract

Goals. To evaluate the impact of Obesity on Community Acquired Pneumonia (CAP) in the pediatric population that has passed the breastfeeding period. Population and methods. Study carried out in the Institute of Tropical Medicine (IMT) of Paraguay in which the cases with NAC in children and adolescents between 2 and 15 years, hospitalized between 2009 and 2013, will be analyzed. The diagnosis of NAC was based on the presence of Febrile respiratory symptomatology and condensation image in the thorax Rx. In each case the presence of fever, tachypnea, runs, chest pain, oxygen saturation (SatO2), laboratorial data (leukocytocyte and platelet count, hemoglobin, liver function), presence of pleural effusion, oxygen requirement (O2) are evaluated. supplementary, need for admission to intensive care unit (ICU), need for mechanical ventilation (ARM), days of hospitalization, and mortality. The weight in kilograms and the height in centimeters were measured. The body mass index was calculated with the formula of BMI = Weight / Size2. The nutritional status is based on the age and agreement of the charts of the World Health Organization (WHO) and the National Center for Health Statistics (NCHS) of the United States (year 2006). The groups of obese and eutrophic patients were compared. Results We analyzed 231 patients between 2 and 15 years old, of which 143 (62%) corresponded to children from 2 to 5 years old and 88 (38%) from 5 to 15 years old. Forty (17%) were obese and 160 (70%) were eutrophic. No difference was found in the presentation of fever (p = 0.9), runs (p = 0.06), chest pain (p = 1). Tachypnea showed a difference in favor of eutrophics (p <0.01). SatO2 <94% in the obese was higher (p <0.05). Regarding the labor data, the GPT values were higher in the obese patients (p <0.05) and the eutrophic ones are published more frequently in the pleural frame (p <0.01). No differences were found in the frequency of use of oxygen therapy (p = 0.7), admission to the ICU (p = 0.3), need for ARM (p = 1) and in the days of hospitalization between both groups. Similarly, there was no difference in mortality: 0/40 vs 4/160 (p = 0.58). Conclusion. The prevalence of obesity is higher than in official records. The clinical presentation and evolution of CAP in obese patients was not found to differ significantly from what is observed in eutrophic patients. However, obese patients with CAP have lower values of SatO2 on admission than eutrophic patients, as an expression of lower gas exchange. In addition, obesity has not been associated with differences in the leukocyte response and Hb levels compared with eutrophic patients, although it has been found higher values of GPT, probably related to liver involvement in obesity. Finally, the Diciembre 2018 Rev. Inst. Med. Trop 2018;13(2)10-21 10.18004/imt/201813210-21 12 length of hospital stay, the frequency of admission to the ICU and mortality were similar in both groups