Clinical Predictors and Respiratory Severity Assessment of Pneumonia in Children with Protein Energy Malnutrition: A Hospital-Based Study

Background: Pneumonia remains a leading cause of morbidity in children with protein-energy malnutrition (PEM), yet atypical presentations frequently complicate bedside diagnosis. This study aimed to evaluate the clinical profile of pneumonia in children with PEM and validate a novel Respiratory Severity Index (RSI) for accurate clinical prediction. Material and Methods: A retrospective cross-sectional study was conducted in a tertiary care teaching hospital involving 70 children (aged 6 months to 12 years) diagnosed with PEM according to the Indian Academy of Paediatrics (IAP) classification. Clinical, nutritional, and radiological data were systematically reviewed. A 4-point RSI was developed by assigning one point each for the presence of tachypnoea, chest retractions, crepitations, and feeding difficulty, and was assessed against radiologically confirmed pneumonia. Results: The incidence of radiologically confirmed pneumonia in the PEM cohort was 25.7%. Classic respiratory signs—specifically cough, tachypnoea, chest retractions, crepitations—along with feeding difficulties, were universally present (100%) in all pneumonia cases and were significantly more common compared to those without pneumonia (p < 0.001). PEM severity (IAP grading) did not significantly correlate with the occurrence of pneumonia (p = 0.824). The RSI demonstrated excellent discriminatory ability for identifying pneumonia, yielding an Area Under the Curve (AUC) of 0.962. Furthermore, all children with confirmed pneumonia clustered in the high-risk RSI category (score of 4), exhibiting significantly higher mean scores than those without pneumonia (4.00 vs. 0.44, p < 0.001). Conclusion: The RSI is a simple, non-invasive, and highly reliable bedside tool that accurately predicts pneumonia in malnourished children. Its routine implementation in resource-limited hospital settings can facilitate early diagnosis, guide prompt management, and ultimately mitigate paediatric morbidity.

Keywords: Protein-Energy Malnutrition; Paediatric Pneumonia; Respiratory Severity Index; Clinical Predictors; Diagnostic Screening; Resource-Limited Settings.