الفهرس 
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Abstract
Our scope was to detect the difference in course of the disease & prognosis between four groups of patients through detailed comparative study and to detect the effect of an abnormal body weight on the child health, disease prognosis and its impact on family and community .Also, we aimed to increase the awareness about over weight, obesity and underweight as a growing health problems affect child’s life .SO, correction of child weight and healthy life style including proper nutrition &adequate physical activities is an important factor for reducing child’s morbidities and mortalities in addition to reducing health care cost and economic burden on families and communities .
The study was conducted on 138 pediatric patients diagnosed with pediatric pneumonia all are recruited from inpatient units, Children’s hospital, Faculty of Medicine, Ain Shams University with age range from 2 up to 14 yrs with a mean age of 7.8 years classified to four groups:
Healthy weight group: including patients with healthy or average BMI (from 5th to below 85th percentile).
Underweight group: including patients with below average BMI (below 5th percentile).
Over weight group: including patients with high average BMI (from 85th to below 95th percentile).
Obese group: including patients with above average BMI (Above 95th percentile).
All children undergone a detailed history taking stressed on dietetic history, daily life style and physical activities, Careful physical examination including complete anthropometric measures including weight, height, mid-arm circumference and skin fold thickness, Calculation of Body Mass Index (BMI) of each child and determination of the centile which child fall in, and Interpretation of Child’s BMI, Detailed chest examination for all signs of lower respiratory tract infections including inspection, palpation, percussion and auscultation, Chest X-ray for diagnosis of lower respiratory tract infections, Laboratory tests at initial diagnosis and follow up including: CBC, ESR, CRP and blood culture, Close follow up and determination of patients who are at risk for development of complications or need of mechanical ventilation, And determination of total cost of admission and treatment and economic burden on the family and community .
Our study revealed that (among our study sample) highest percentage of infection was in underweight females =66.7% and the least percentage was among underweight males=33.3% (P value = 0.3). Obese patients was more liable for respiratory distress, as, 50% of them was presented at grade 2 respiratory distress at time of admission, while the percentage was 8.8% within average weight group (P value =0, 01).
Obese and overweight group showed increase in the need & duration of Mechanical ventilation (12.5%), while healthy weight group did not need mechanical ventilation by 92.9%. (P value =0,004). Also, there is double increase in complications and underweight (44.4%) &obese patients (50%) in comparison to (10.6%) complicated cases within average weight group (P value =0,002). Pneumothorax was the most frequent complication among obese patients group (25%), while pleural effusion was the most frequent complication underweight group(22.2% ), In comparison to 0.9% from average weight group developed empyema (P value =0,001) .
Duration of hospital admission among underweight patients was the longest duration (5 days) by 44.4% (P value =0,005), Also, paternal work absenteeism was increased in parents of underweight and obese patient (P value =0.02),In addition, duration of maternal work absenteeism among overweight group was the most long duration,(P value =0.02) .Other hand, underweight patients were of the longest school absenteeism period (P value =0.004).
So, our results revealed that the obese child was more liable for respiratory distress, disease complications as pneumothorax, had a higher risk for need of mechanical ventilation &increased its duration and increased duration of their paternal work absenteeism.
Overweight child were also had increased risk for mechanical ventilation and increased maternal work absenteeism.
As regard underweight child they were more liable for complications as pleural effusion, longer duration of hospital admission and longer duration of school absenteeism.
So, an abnormal pediatric body weight and abnormal BMI had a direct impact on child health, well being, affect pediatric mortality and morbidity and have a negative effect on health care cost and an increased economic burden on family and community.
Conclusion
Abnormal pediatric body mass index had a direct impact on the child health, well-being, and affect health care cost and increase economic burden on family and community.
These children more liable for complications, mechanical ventilation, longer duration of hospital admission and increase school absenteeism which all are negative effects on patient, family and community.
Recommendations
from the present study, the following are to be recommended:
(1) Frequent detailed anthropometric measures to all children, with BMI screening and should be incorporated into the diagnostic work up of children with serious infectious diseases.
(2) Proper management and early treatment of children with lower respiratory tract infections especially patients with abnormal BMI.
(3) Determination of proper treatment programs for children who are overweight, obese and underweight children.
(4) Increase the social weariness about importance of proper healthy dietetic habits and daily physical exercise activities.
(5) Close follow up of children with abnormal BMI who are allergic or suffering from recurrent infections to prevent spread of infection or exposure to complications.
(6) Further studies are recommended with larger number of patients.