الفهرس 
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Abstract
Pneumonia is one of the infectious diseases that affects the lower respiratory tract system (Katz & Williams, 2018). Pneumonia is an acute infection affecting the lung and alveoli that can be caused by many different micro-organisms (viruses, bacteria, or fungi), in which pathogens enter the lung, causing inflammation and weakening the gas exchange mechanism between alveoli and pulmonary capillaries (Hamed et al., 2019; Jafarzadeh and Oscuii, 2019; LI et al., 2020).
Community acquired pneumonia (CAP) is the most common type of pneumonia where individuals are affected by the pathogen away from hospitals or other health care facilities (Symington & Scott, 2017).
One of the most common responsible co-factors between the high incidence of death due to CAP and development countries is micronutrient deficiencies which have an important role in the regulation of essential defense mechanisms of the human body against infectious diseases and is very essential as well for appropriate cellular and molecular functions, including the cell of immunity system (Kuti et al., 2021; Rahman et al., 2022).
Essential micronutrients including zinc and vitamin A have an important role in many vital pathways affecting immunity and human health, where their deficiency is considered one of the risk factors for respiratory infections (Reyes et al., 2002; Hoang and Han, 2021).
Zinc has an essential role in different stages of immune response against the infections (Gombart et al., 2020). It is essential for gene expression and has an important role in nucleic acid and protein synthesis, cell replication, tissue growth and repair, and is vital for regulation of immune system function and defensive mechanisms against infectious micro-organisms (Hoang and Han, 2021; Jegalakshmi et al., 2022).
Zinc deficiency increases vulnerability to oxidative DNA damage, causes enhanced oxidative stress, decreases macrophage functions (such as phagocytosis, intracellular killing, respiratory burst generation, and chemotaxis), and increases susceptibility to infection (Haryanto et al., 2015).
Vitamin A is also one of the most important micronutrients, which is essential for many vital functions such as epithelial integrity, and immune system response, and is considered an anti-infectious vitamin due to its essential role in immune function through controlling the discrimination of T-helper cells to Th2 and production of interleukin-4 and interleukin-5, regulating the humoral antibody response, and inhibition of bacteria growth (Abd El-Shaheed et al., 2018; Shahzad et al., 2018). Vitamin A also acts as an antioxidant agent, preventing oxidative stress and cell damage (Khadim and Al-Fartusie, 2021).
Vitamin A deficiency results in blindness and anaemia, worsens vaccine reactions, and raises the risk of morbidity and mortality from infectious diseases, particularly those affecting the respiratory tracts (Villamor & Fawzi, 2005) .
The aim of this study was to investigate the efficacy and safety of zinc supplementation compared to vitamin A as an adjuvant to the standard protocol of therapy used in the management of pneumonia in pediatric patients. This was performed through the evaluation of the role of each on the recovery rate in paediatric patients with pneumonia in terms of hospital stay and pneumonic effusion duration.
A comparative, randomized, open label, controlled, pilot, interventional study was carried out from January 2019 till February 2020. The study carried out on 75 patients aged from 6 months to 5 years were diagnosed as CAP and admitted to paediatric intensive care unit. The participated patients were divided into three groups.
group A, in addition to the standard therapy, patient had administered zinc on dose of 10 mg/once daily for children less than 1 years, or 20 mg/once daily in children more than 1 years old for seven days.
group B, in addition to the standard therapy, patient had administered dose of vitamin A on dose of 50000 IU in day one and day five for children less than 1 years, or 100000 IU daily in children more than 1 years old for seven days.
group C was the control group, where the patients were admitted only the standard therapy.
For all participated patient, we daily monitored the body temperature, respiratory rate, and oxygen saturation was monitored daily through pulse oximetry. At the admission and every three days, we monitored C - reactive protein, arterial blood gases [PCO2, PO2, and pH], kidney function [serum creatinine, blood urea nitrogen (BUN)], and liver function [alanine aminotransferase (ALT), aspartate aminotransferase (AST) were performed. In addition to closely monitoring to zinc and vitamin A side effects.
The findings of the study showed that administration of either zinc or vitamin A supplementation in community acquired pneumonia in children aged less than 5 years significantly reduce the hospitalization stay and duration of effusion compared to the control group with a non- significant difference between the effect of zinc and/or vitamin A supplementation.