الفهرس 
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Abstract
Lower respiratory tract infections (LRTIs) include all infections of the lungs and the large airways below the larynx and include croup syndromes, bronchitis, bronchiolitis and pneumonia. On average, children below 5 years of age suffer about 5 to 6 episodes of LRTI per year, and still a burden until 12 years of age and more. (Christi et al., 2009).
Pneumonia is the single largest infectious cause of death in children worldwide. Pneumonia killed an estimated 922000 children under the age of 5 in 2015, accounting for 15% of all deaths of children under five years old. Pneumonia affects children and families everywhere, but is most prevalent in South Asia and sub-Saharan Africa (WHO, 2015).
Anemia is a major public health problem that can occur at any stage of the life cycle, but is more prevalent in pregnant women and young children having iron deficiency (Benoist et al., 2008).
LRTI associated with anemia occurs more commonly in children than in adults, with anemia affecting approximately 30% of children all over the world (Brotanek et al., 2007). Iron deficiency anemia in children occurs most frequently between the age of 6 months and 3 years, the same period of age when repeated infections occur (Malla et al., 2010).
Iron deficiency exert adverse effects on immune response and alters the metabolism and growth of pathogens (Ramakrishnan and Borade, 2010).
Whatever the etiology of anemia, the relation between low hemoglobin level and LRTI has not been fully evaluated, and only few reports are available evaluating this subject (Ramakrishnan and Harish, 2006).
The aim of this study is to evaluate the role of iron deficiency anemia as a risk factor for lower respiratory tract infections in pediatrics. This study was case-control study, it was conducted on a total number of 100 infants and children aged 6 months to 5 years, who attended the out patient pediatric clinic and/or hospitalized by lower respiratory tract infections in Pediatrics department in Benha University hospital in the period from March 2015 to March 2016, after a concept of their parents, They were classified into 2 group: group I: it included 50 infants and children with mean age 28.32±16.34 months, there were 36 males and 14 females and group II: it included 50 apparently healthy infants and children without any respiratory problems, age and sex matched with mean age 28.28±16.59 months, there were 37 males and 13 females, attending out patient clinic.
All patients were subjected to detailed history taking, full clinical examination and investigation including CBC, Iron profile: serum ferritin serum iron and total iron binding capacity, CRP and Chest X ray were done for cases only.
In our study there was male sex predominant among infants and children with LRTIs with no statistical significant difference between cases and control group as regard to residence. According to clinical findings of the studied patients revealed that the most presentation symptoms for LRTIs is cough (100%), then fever (98%), poor feeding (62%), dyspnea (58%) and according to degree of respiratory distress RD grade I (24%), RD grade II (10%), RD grade III (10%) and RD grade IV (14%). And according to diagnosis of LRTIs the most of cases were pneumonia (46%), then acute bronchitis 30% and bronchiolitis 24%.
There was statistical significant difference between studied groups (cases and controls) regarding presence of anemia with OR of 4.64, 95% CI (1.99-10.80) and presence of iron deficiency anemia with OR of 4.75, 95% CI (2.02-11.14), and there was statistical significant difference between cases and control group as regarding laboratory parameters (HB, RBCs count, MCV, MCH, MCHC, RDW-CV%, Serum iron, Serum ferritin, TIBC, Transferrin saturation).