AN OVERVIEW OF SECONDARY IMMUNODEFICIENCY STATES IN CHILDREN ADMITTED TO PAEDIATRIC INTENSIVE CARE UNIT IN A TERTIARY CARE HOSPITAL IN GUNTUR DISTRICT OF ANDHRA PRADESH

Abstract

Objective: To review the different causes of secondary immunodeciencies in children requiring prolonged hospital stay or recurrent hospital admissions and provide clinicians with an updated overview of potential factors that contribute to immunodeciency in a tertiary care hospital over 18 months. Background Immunocompromised status is the common cause of morbidity and mortality in hospital-admitted children. Secondary immunodeciency contributes to most of the immunocompromised states rather than primary, resulting from a variety of extrinsic factors that can affect a host with an intrinsically normal immune system, including undernutrition, infectious agents, drugs, metabolic diseases, and environmental conditions. In routine clinical practice, these arise from a number of conditions, such as treatment with glucocorticoids and immuno-modulatory drugs, surgery and trauma, extreme environmental conditions, and chronic infections, such as those caused by HIV. The most common cause of immunodeciency is malnutrition, affecting many communities around the world with restricted access to food resources [1]. Methods This is a retrospective observational study using hospital records of children aged 1 month to 12 years, admitted to PICU from January 2021 to August 2022 in a tertiary care hospital in the Guntur district of Andhra Pradesh, India, who were underweight, or on some immunosuppressive agents and those who had hospital stay lasting more than 14 days and who needed >14 days of intravenous antibiotic. Results In children less than 1 year, protein energy malnutrition especially SAM is the most common cause of secondary immunodeciency. Among children older than 1 year, children using steroids for nephrotic syndrome constitute the major cause. As secondary immunodeciency Conclusion disorders are far more common than primary immunodeciency disorders. PEM is the most common cause in children less than 1 year, Exclusive breastfeeding should be advised to all children, and attention to nutritional supplementation should be given as early as possible. Even brief exposure to steroids may land children into a state of immunosuppression, so judicious use of steroids is mandatory and regular follow-up is necessary.