Nutritional support in children with community-acquired pneumonia
Authors: Kremplevskaya S.P. ,   Central Research Institute of Epidemiology, Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing, Moscow, Russian Federation, Muzyka А.D. , Melekhina Е.V. , Gorelov A.V. ,   Khimki Regional Hospital, Khimki, Russian Federation,   Central Research Institute of Epidemiology, Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing, Moscow, Russian Federation,   Central Research Institute of Epidemiology, Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing, Moscow, Russian Federation,   Khimki Regional Hospital, Khimki, Russian Federation,   Central Research Institute of Epidemiology, Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing, Moscow, Russian Federation
Published: July 2024

The nutritional status (NS) of a patient with an acute infectious disease often determines its course and prognosis. One of the factors involved in the formation and maintenance of NS is the state of the microbiome of various loci of the macroorganism. Such an integrated approach to the treatment of lower respiratory tract infections in pediatric practice has not been studied. Objective. Optimization of dietary therapy of children over 3 years old with out-of-hospital pneumonia based on the study of NS. Patients and methods. Eighty children (3–10 years old, 43 girls and 37 boys) hospitalized with out-of-hospital pneumonia of moderate severity in the children's infectious diseases department of the Khimki Regional Hospital were examined. The main group (40 children) received Resource® Clinutren® Junior product throughout hospitalization, the comparison group (40 children) received a standard diet. Additionally, the physical development of patients was assessed using the World Health Organization AnthroPlus program, Nutrishional Risk Screening (NRI). Bioimpedanceometry was performed daily (active cell mass (ACM) and fat mass were determined). The gut microbiome was examined by 16S genome sequencing before and after antibiotic therapy. Results. Protein metabolism disorders were recorded in 88.7% of children with out-of-hospital pneumonia in the acute febrile period according to bioimpedanceometry. By the time of discharge in children who received general-age nutrition, the decrease of ACM index remained in 57% of cases (23/40 of the comparison group). The use of Resource® Clinutren® Junior in children in the acute febrile period leads to the recovery of ACM already on the second day from the beginning of diet therapy. From the second day of observation, reliable differences between the number of children with normalization of temperature and appetite in the main group and the comparison group (57.5% & 25%, p < 0.01) were registered. Normalization of temperature was achieved in all children of the main group by the 4th day of hospitalization, in all children of the comparison group – by the 5th day. Normalization of appetite by the time of discharge was achieved in all patients of the main group and in 97.5% of patients of the comparison group. The duration of productive cough in the main group was shorter than in the experimental group (Me in the main group was 3 (IQR 2–4) days, in the comparison group – 4 (IQR 3–5.25) days. In the main group of patients who took specialized nutrition Resource® Clinutren® Junior, we observed a rarer development of antibiotic-associated syndrome (ASS) symptoms (45% & 55%) and rapid relief of its manifestations (reduction of abdominal bloating in 47.5% of patients, reduction of diarrheal syndrome in 70% of cases). Analysis of 16S sequencing data demonstrated a more rapid recovery of beta diversity by reducing the proportion of diseaseassociated microorganisms. Conclusions. Connection of Resource® Clinutren® Junior product in the acute febrile period of out-of-hospital pneumonia in children 3 years and older from the first days of the disease leads to faster relief of the main symptoms of the disease, prevents the development of AAS due to normalization of protein metabolism indicators and restoration of intestinal microbiome. Key words: Resource® Clinutren® Junior, nutritional status, nutritional deficiency, nutritional support, bioimpedanceometry