الفهرس 
Introduction
Aim of workOnly 14 pages are availabe for public view
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Abstract
This study was done in Pediatric Assiut University Hospital for one year from 1 February 2017 to 31 January 2018 .All cases with pneumonia admitted to all units in the hospital have pneumonia were 872 case and 110 cases fulfilled the inclusion criteria of recurrent pneumonia.
Diagnosis of recurrent pneumonia based on history of two episodes of pneumonia occurring in 1 year or three episodes of pneumonia occurring in any time frame, only cases which met inclusion criteria were included in our study specifically their having radiological evidence of two chest X rays with diagnosis of pneumonia with completely resolved chest X ray from pneumonia in-between
Approximately 1 in 12 children with pneumonia in our locality have recurrent pneumonia with percentage of 12.61%.
The most frequent underlying cause for recurrent pneumonia in Assiut University Children’s Hospital which present the largest referral pediatric hospital in Upper Egypt for one year according to our study was cardiac diseases especially congenital heart diseases 25.45%, the second most frequent cause was immunodeficiency diseases 20.9% followed by bronchial asthma 16.36%. Other causes include chronic lung diseases, pulmonary T.B, aspiration syndrome, anatomical congenital respiratory anomalies and cystic fibrosis arranged respectively, while the etiology of recurrence was unknown in 6.36 % of the cases.
Diagnosis of recurrent pneumonia based on history of two episodes of pneumonia occurring in 1 year or three episodes of pneumonia occurring in any time frame, only cases which met inclusion criteria were included in our study specifically their having radiological evidence of two chest X rays with diagnosis of pneumonia with completely resolved chest X ray from pneumonia in-between. The results showed that 65.5% of studied cases were males.
The majority of the included patients were belonged to age group between 0-3 years 62.7%.The % frequency of the patients belonged to urban areas 77.2% was proved to be significantly higher than those from rural areas 22.72% in all age groups.
Study of the socio-economic status of the included patients, according to El Sherbini modified classification score, (2012). According to maternal domain about half of mothers read & write 54.54%.Regarding occupation parents domain, there were 54.54% of the parents were skilled manual worker. In economic domain the majority of cases 84.54% had met routine expenses &emergencies. Also all cases had number of family members more than 5 members. Regarding crowding index there were about 94.5% of cases had more than one person/room. 48.18% of the studied families belonged to middle class, while 43.63% were classified as low class.
There was history of cough among 94.54% of the studied patients, while 56.36% had history of fever and 50.0% had recurrent upper respiratory tract infection. About 22.72% cases had history of atopy/allergy and about 11.81% of cases had history of immune-deficiency from first months of age.
The history of atopy and allergy was noticeable significantly higher among female patients in different age groups.
As regard to investigations were done to studied group, children aged between 1-3 years showed significantly lower mean hemoglobin levels in comparison with other age groups.
Among immunodeficient patients, 52.17% were due to B-cell deficiency, while 26.08% were diagnosed as phagocytic cell defect.
Among cardiac patients, TGA was diagnosed in 17.8 % of the cases, while 28.7% of cardiac patients with a cyanotic heart disease had ventricular septal defect.
As regard to risk factors in studied group. Prematurity was detected among 7.27 % of the cases while more than 50% were formula fed and more than 60% exposed to pollution. Father smoking was detected among 36.36% of cases. Patients aged > 6 years showed significantly higher frequency in risk factors as obesity, indoor and outdoor pollution and use of steroids in comparison to other age groups. However, patients aged 0-3 years exhibited significantly higher % frequency of having heart disease, oro-motor in coordination /swallowing dysfunction, GERD and under nutrition as risk factors for recurrent pneumonia in comparison to other age groups.
We also noticed significantly higher rate of episodes of RP /year among age group between0-3yrs than other age groups. Also there were higher numbers of episodes of RP /year in cases with bronchial asthma, cardiac disease and anatomical congenital respiratory anomalies than other co-morbid conditions.