Pediatrics World Conference 2026

Abstract

Background
Pneumonia remains a leading cause of morbidity and mortality among children under five years of age, particularly in low- and middle-income countries. Zinc deficiency is prevalent in these settings and has been associated with impaired immune function and increased susceptibility to respiratory infections. While zinc supplementation has demonstrated benefits in the prevention of pneumonia and in the treatment of diarrhea, its role as an adjunct therapy during acute severe pneumonia remains uncertain. This study aimed to evaluate the effect of zinc supplementation on clinical recovery and hospital outcomes in children with severe pneumonia.

Methods
We conducted a randomized, double-blind, placebo-controlled clinical trial at a tertiary care teaching hospital. Children aged 2 months to 5 years (n = 122) diagnosed with severe pneumonia according to World Health Organization (WHO) criteria were enrolled. Participants were randomized in a 1:1 ratio to receive either oral elemental zinc (10 mg twice daily for 7 days) or a matching placebo, in addition to standard antimicrobial and supportive therapy. Baseline demographic, anthropometric, and clinical variables—including age, sex, nutritional status, hemoglobin levels, respiratory rate, oxygen saturation, and other signs of respiratory distress—were recorded at enrollment. The primary outcome was time to resolution of severe pneumonia. Secondary outcomes included duration of hospital stay, duration of nil per oral status, duration of intravenous fluid and oxygen therapy, and need for escalation to second- or third-line antibiotics. Statistical analysis was performed using chi-square tests for categorical variables and t-tests or Mann–Whitney U tests for continuous variables, as appropriate. A p-value <0.05 was considered statistically significant.

Results
Baseline demographic and clinical characteristics were comparable between the zinc and placebo groups (all p >0.05). There were no significant differences in respiratory rate, chest indrawing, cyanosis, stridor, nasal flaring, wheeze, or fever at enrollment. The median (interquartile range) time to resolution of severe pneumonia was 34.2 hours (21.0–48.0) in the zinc group compared with 26.0 hours (16.0–46.0) in the placebo group (p = 0.219). The median duration of hospital stay was 73.5 hours (49.5–107.5) in the zinc group and 72.0 hours (48.0–87.7) in the placebo group (p = 0.193). No significant differences were observed in secondary outcomes, including oxygen requirement or need for antibiotic escalation.

Conclusions
Adjunctive zinc supplementation during the acute management of severe pneumonia did not significantly reduce the duration of illness or length of hospital stay. These findings do not support routine therapeutic zinc supplementation for children hospitalized with severe pneumonia, although its role in prevention remains important.