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Seidu TA, Brion LP, Heyne R, Brown LS, Jacob T, Edwards A, Lair CS, Wyckoff MH, Nelson DB, Angelis D. Improved linear growth after routine zinc supplementation in preterm very low birth weight infants. Pediatr Res 2025:10.1038/s41390-025-03935-z. [PMID: 40069483 DOI: 10.1038/s41390-025-03935-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2024] [Revised: 01/14/2025] [Accepted: 01/21/2025] [Indexed: 03/15/2025]
Abstract
BACKGROUND This study was designed (1) to compare growth, morbidity and mortality in < 33-week gestational age (GA) (very preterm, VPT) or very low birth weight (BW < 1500 grams, VLBW) infants before (Epoch-1) and after implementing routine enteral zinc (Zn) supplementation (Epoch-2) to meet recommendations, and (2) to assess serum Zn levels and associated variables. METHODS Single-center prospective cohort of 826 infants. The primary outcome was the change (Δ) in Z-scores of accurate length (Δlengthz), weight and head circumference from birth to discharge home. RESULTS In Epoch-2 vs Epoch-1 Δlengthz adjusted for confounding variables increased by 0.27 [95% confidence interval (CI) 0.13, 0.42, P < 0.001]. However, morbidity and mortality did not change. In Epoch-2 Zn decreased with GA and postnatal age: low ( < 0.74 mcg/mL) levels were observed in 51% infants. Retinopathy of prematurity (ROP) was independently associated with the lowest Zn [adjusted odds ratio 0.042 (CI 0.006, 0.306), area under the curve=0.928]. CONCLUSION Routine enteral Zn supplementation was independently associated with improved linear growth but did not prevent occurrence of low Zn. ROP was independently associated with the lowest Zn. IMPLICATIONS Multicenter studies are needed to assess whether dosage of enteral Zn should be increased and whether Zn could help prevent ROP. IMPACT Implementation of routine enteral zinc (Zn) supplementation was associated with improved linear growth from birth to discharge and a more frequent physiologic growth curve in preterm very low birth weight infants. Serum Zn levels decreased with gestational age and with postnatal age. Low serum Zn levels were observed frequently despite routine Zn supplementation as currently recommended, which suggests a need to re-evaluate current enteral zinc supplementation guidelines for this population. Retinopathy of prematurity among infants < 33 weeks' gestation was independently associated with low gestational age, low birthweight, stage of bronchopulmonary dysplasia and the lowest serum Zn level.
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Affiliation(s)
- Tina A Seidu
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Children's Health, Dallas, TX, USA
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Luc P Brion
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Roy Heyne
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | | | | | | | - Myra H Wyckoff
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - David B Nelson
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Dimitrios Angelis
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA.
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Oliveira RG, Achcar-Feih MC, Nogueira-Pileggi V, Carnevale-Silva A, Carmona F, Aragon DC, Oliveira MM, Fonseca LMM, Alves LG, Bomfim VS, Trevilato TMB, Spido-Dias I, Ued FV, Mussi-Pinhata MM, Camelo JS. Analysis of zinc and copper levels in very low birth weight infants using human milk additives: phase 1 trial findings. J Pediatr (Rio J) 2025; 101:187-193. [PMID: 39374901 PMCID: PMC11889681 DOI: 10.1016/j.jped.2024.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 08/03/2024] [Accepted: 08/05/2024] [Indexed: 10/09/2024] Open
Abstract
OBJECTIVE The aim of this study was to assess whether the micronutrients zinc and copper, provided by human milk additives, are sufficient for very low birth weight preterm infants. METHOD A phase 1 randomized double-blind controlled trial was conducted with very low birth weight preterm infants. This is a secondary analysis of copper and zinc. Sixty-six newborns were part of the initial sample, with forty participating and reaching the final stage of the study. Inclusion criteria were: gestational age less than 37 weeks, birth weight greater than or equal to 750 g and less than or equal to 1500 g, small or appropriate for gestational age, exclusively receiving human milk at a volume greater than or equal to 100 mL per kilogram per day, and hemodynamically stable. Participants were randomly assigned to two groups: intervention, Lioneo (received human milk with additive based on lyophilized human milk), n = 20, and control, HMCA (received human milk with commercial additive based on cow's milk protein), n = 20, and their serum levels of zinc and copper were measured on the first and twenty-first days. RESULTS There was a reduction in intragroup zinc serum levels from the first to the twenty-first day of the study (p < 0.01). There was no intergroup difference. No difference was found in serum copper levels. CONCLUSION Human milk additives were not sufficient to maintain adequate zinc serum levels in very low birth weight newborns. It was not possible to affirm whether human milk additives were sufficient to maintain adequate serum copper levels in the studied sample. UTN: U1111-1220-0550.
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Affiliation(s)
- Renata G Oliveira
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Brazil
| | - Maria C Achcar-Feih
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Brazil
| | - Vicky Nogueira-Pileggi
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Brazil
| | | | - Fabio Carmona
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Brazil
| | - Davi C Aragon
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Brazil
| | - Mariana M Oliveira
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Brazil
| | - Luciana M M Fonseca
- Department of Maternal-Infantile and Public Health, Nursing School of Ribeirão Preto, University of São Paulo, Brazil
| | - Larissa G Alves
- Human Milk Bank, Clinics Hospital, Ribeirão Preto Medical School, University of São Paulo, Brazil
| | - Vanessa S Bomfim
- Human Milk Bank, Clinics Hospital, Ribeirão Preto Medical School, University of São Paulo, Brazil
| | - Tânia M B Trevilato
- Laboratory of Pediatrics, Division of Metals and Rare Diseases, Clinics Hospital, Ribeirão Preto Medical School, University of São Paulo, Brazil
| | - Isabela Spido-Dias
- Laboratory of Pediatrics, Division of Metals and Rare Diseases, Clinics Hospital, Ribeirão Preto Medical School, University of São Paulo, Brazil
| | - Fabio V Ued
- Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Brazil
| | - Marisa M Mussi-Pinhata
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Brazil
| | - Jose S Camelo
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Brazil.
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Sahin S, Sari FN, Bidev D, Bozkurt O, Dizdar EA, Oguz SS. Zinc Supplementation in Very Low Birth Weight Infants: A Randomized Controlled Trial. Am J Perinatol 2024; 41:e3107-e3114. [PMID: 37939725 DOI: 10.1055/s-0043-1776762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
OBJECTIVE Preterm infants have high zinc (Zn) requirements and are generally believed to be in a negative Zn balance in the early period of life. In this study, we aimed to investigate the effect of high-dose Zn supplementation in very low birth weight (VLBW: infants with birth weight < 1.5 kg) infants on feeding intolerance and development of mortality and/or morbidities including necrotizing enterocolitis (NEC) and late-onset sepsis (LOS). STUDY DESIGN This is a prospective randomized trial. VLBW preterm infants with gestational age of <32 weeks were randomly allocated on the seventh day of life to receive extra amount of supplemental Zn along with the enteral feedings (9 + 3 mg), besides regular low-dose supplementation (3 mg), from enrollment until discharge. Outcome measures were feeding intolerance, NEC (stage ≥ 2), LOS, and mortality. RESULTS A total of 195 infants (97 from study group and 98 from control group) were analyzed. A total of 46 (47.4%) infants in the study group and 64 (65.3%) infants in the control group ended up with feeding intolerance (p = 0.012). NEC was observed in 11 infants (11.2%) in the control group and only 1 infant (1%) in the study group (p = 0.003). There was a negative correlation between high-dose Zn supplementation and number of culture-proven LOS episodes (p = 0.041). This significance was also present for clinical sepsis, being higher in the control group (p = 0.029). No relationship between high-dose Zn supplementation and mortality and other morbidities (hemodynamically significant patent ductus arteriosus, bronchopulmonary dysplasia, retinopathy of prematurity, and severe intraventricular hemorrhage) was observed. CONCLUSION Zn supplementation for VLBW infants is found to be effective to decrease feeding intolerance, NEC, and LOS episodes in this vulnerable population. Current data support the supplementation of VLBW infants with higher than regular dose of Zn. KEY POINTS · Higher dose of Zn supplementation is shown to be a beneficial intervention in VLBW infants.. · Zn may decrease feeding intolerance, sepsis or NEC.. · Higher than regular dose of Zn seems to be safe..
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Affiliation(s)
- Suzan Sahin
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Izmir Demokrasi University, Izmir, Türkiye
| | - Fatma N Sari
- Division of Neonatology, Department of Pediatrics, University of Health Sciences, Ankara City Hospital, Ankara, Türkiye
| | - Duygu Bidev
- Division of Neonatology, Department of Pediatrics, Koru Sincan Hospital, Ankara, Türkiye
| | - Ozlem Bozkurt
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Kocaeli University, Kocaeli, Türkiye
| | - Evrim A Dizdar
- Division of Neonatology, Department of Pediatrics, University of Health Sciences, Ankara City Hospital, Ankara, Türkiye
| | - Serife S Oguz
- Division of Neonatology, Department of Pediatrics, University of Health Sciences, Ankara City Hospital, Ankara, Türkiye
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Association of serum and erythrocyte zinc levels with breastfeeding and complementary feeding in preterm and term infants. J Dev Orig Health Dis 2023; 14:53-60. [PMID: 35903854 DOI: 10.1017/s2040174422000447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Zinc is an important nutrient involved in cell division, physical growth, and immune system function. Most studies evaluating the nutritional status related to zinc and prematurity were conducted with hospitalized preterm infants. These studies show controversial results regarding the prevalence of deficiency, clinical implications, and the effect of zinc supplementation on mortality, infectious diseases, and growth in these groups. This study aimed to compare serum and erythrocyte zinc levels in a group of preterm and full-term infants after 9 months of age, and related the zinc levels to dietary intake and anthropometric indicators in both groups. This cross-sectional study compared 43 preterm infants (24 to 33 weeks) aged 9-24 months to 47 full-term healthy infants. Outcome measures: anthropometric indicators and dietary intake. Blood sample for serum and erythrocyte zinc levels (ICP-MS, Inductively Coupled Plasma Mass Spectrometry). There was no difference between the groups regarding the mean of serum and erythrocyte zinc. Variables associated with higher serum zinc levels were breastfeeding at evaluation (β = 20.11 µg/dL, 95% CI 9.62-30.60, p < 0.001) and the later introduction of solid foods (β = 6.6 µg/dL, 95% CI 5.3-11.4, p < 0.001). Breastfeeding was also associated with higher erythrocyte zinc levels. The zinc levels were adequate in both groups, there was no association with anthropometric indicators or dietary intake and were slightly influenced by breastfeeding and time of solid food introduction.
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Gates A, Marin T, De Leo G, Waller JL, Stansfield BK. Nutrient composition of preterm mother's milk and factors that influence nutrient content. Am J Clin Nutr 2021; 114:1719-1728. [PMID: 34293087 PMCID: PMC10157816 DOI: 10.1093/ajcn/nqab226] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 06/11/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Breast milk feedings are the optimal feeding choice for premature infants. Clinicians depend on accurate nutrient profiles of the breast milk in order to make informed decisions regarding the need for nutrient supplementation. Existing data for nutrient composition of preterm breast milk are dated and not representative of the current population of women delivering prematurely in the United States. OBJECTIVES The purpose of this prospective, longitudinal, single-center observational study was to measure the macronutrient and micronutrient composition of breast milk expressed by mothers, including women who self-identify as black, delivering preterm infants at ≤33 completed weeks of gestation. METHODS We collected breast milk samples from mothers of preterm infants admitted to the neonatal intensive care unit at Augusta University Medical Center from January 2019 through November 2019. Mother's milk samples were collected on postpartum days 7, 14, 21, and 28 and analyzed for macronutrients (energy, fat, protein, and carbohydrates) and micronutrients (sodium, potassium, chloride, calcium, phosphorus, magnesium, vitamin D, and zinc). RESULTS Thirty-eight mothers, mean age 27 ± 5.1 y and majority black (66%), provided milk for the study. The mean estimated gestational age and birth weight were 28.2 ± 2.8 weeks of gestation and 1098 ± 347 g, respectively, with 42% of mothers in the cohort delivering before week 28 of pregnancy. Differences in protein, sodium, potassium, calcium, phosphorus, and zinc concentrations based on race, day, and milk volume were identified. Dilution effects for protein, sodium, chloride, and vitamin D concentrations over time were identified. CONCLUSIONS Our study is among the first to characterize breast milk composition from women who delivered extremely preterm infants and adds to the evidence that race, gestational age, and volume influence the composition of preterm mother's milk. These factors should be considered when designing mother's milk-based feeds for premature infants.
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Affiliation(s)
- Amy Gates
- College of Allied Health Sciences, Augusta University, Augusta, GA, USA
| | - Terri Marin
- College of Nursing, Augusta University, Augusta, GA, USA
| | - Gianluca De Leo
- College of Allied Health Sciences, Augusta University, Augusta, GA, USA
| | - Jennifer L Waller
- Division of Biostatistics and Data Science, Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Brian K Stansfield
- Department of Pediatrics, Medical College of Georgia, Augusta University, Augusta, GA, USA
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Brion LP, Heyne R, Lair CS. Role of zinc in neonatal growth and brain growth: review and scoping review. Pediatr Res 2021; 89:1627-1640. [PMID: 33010794 DOI: 10.1038/s41390-020-01181-z] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 09/14/2020] [Accepted: 09/18/2020] [Indexed: 12/11/2022]
Abstract
This manuscript includes (1) a narrative review of Zinc as an essential nutrient for fetal and neonatal growth and brain growth and development and (2) a scoping review of studies assessing the effects of Zinc supplementation on survival, growth, brain growth, and neurodevelopment in neonates. Very preterm infants and small for gestational age infants are at risk for Zinc deficiency. Zinc deficiency can cause several complications including periorificial lesions, delayed wound healing, hair loss, diarrhea, immune deficiency, growth failure with stunting, and brain atrophy and dysfunction. Zinc is considered essential for oligodendrogenesis, neurogenesis, neuronal differentiation, white matter growth, and multiple biological and physiological roles in neurobiology. Data support the possibility that the critical period of Zinc delivery for brain growth in the mouse starts at 18 days of a 20-21-day pregnancy and extends during lactation and in human may start at 26 weeks of gestation and extend until at least 44 weeks of postmenstrual age. Studies are needed to better elucidate Zinc requirement in extremely low gestational age neonates to minimize morbidity, optimize growth, and brain growth, prevent periventricular leukomalacia and optimize neurodevelopment. IMPACT: Zinc is essential for growth and brain growth and development. In the USA, very preterm small for gestational age infants are at risk for Zinc deficiency. Data support the possibility that the critical period of Zinc delivery for brain growth in the mouse starts at 18 days of a 20-21-day pregnancy and extends during lactation and in human may start at 26 weeks' gestation and extend until at least 44 weeks of postmenstrual age. Several randomized trials of Zinc supplementation in neonates have shown improvement in growth when using high enough dose, for long duration in patients likely to or proven to have a Zinc deficiency. Studies are needed to better elucidate Zinc requirement in extremely low gestational age neonates to minimize morbidity, optimize growth and brain growth, prevent periventricular leukomalacia and optimize neurodevelopment.
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Affiliation(s)
- Luc P Brion
- University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | - Roy Heyne
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Cheryl S Lair
- Parkland Health and Hospital System, Dallas, TX, USA
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Ilardi L, Proto A, Ceroni F, Morniroli D, Martinelli S, Mosca F, Giannì ML. Overview of Important Micronutrients Supplementation in Preterm Infants after Discharge: A Call for Consensus. Life (Basel) 2021; 11:331. [PMID: 33920163 PMCID: PMC8069002 DOI: 10.3390/life11040331] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 04/07/2021] [Accepted: 04/07/2021] [Indexed: 01/10/2023] Open
Abstract
Preterm infants have a lower level of nutrient body stores and immature body systems, resulting in a higher risk of malnutrition. Imbalanced complementary feeding could lead to further risk of nutritional deficits and excesses. However, evidence on their nutritional requirements following hospital discharge is limited. When planning complementary feeding, appropriate micronutrient intake should be considered for their critical role in supporting various body functions. This narrative review summarizes the need for iron, zinc, vitamin D, calcium, phosphate and long-chain polyunsaturated fatty acids (LCPUFAs) supplementation in preterm infants during complementary feeding. Regarding iron and vitamin D, the scientific community is reaching an agreement on supplementation in some categories of prematures. On the contrary, there is still not enough evidence to detail possible recommendations for LCPUFAs, zinc, calcium and phosphorus supplementation. However, these micronutrients are paramount for preterms' health: LCPUFAs can promote retinal and brain development while calcium and phosphorus supplementation is essential to prevent preterms' metabolic bone disease (MBD). Waiting for a consensus on these micronutrients, it is clear how the knowledge of the heterogeneity of the prematures population can help adjust the nutritional planning regarding the growth rate, comorbidities and comprehensive clinical history of the preterm infant.
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Affiliation(s)
- Laura Ilardi
- Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (L.I.); (A.P.); (S.M.)
| | - Alice Proto
- Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (L.I.); (A.P.); (S.M.)
| | - Federica Ceroni
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy; (F.C.); (F.M.)
| | - Daniela Morniroli
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, NICU, 20122 Milan, Italy;
| | - Stefano Martinelli
- Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (L.I.); (A.P.); (S.M.)
| | - Fabio Mosca
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy; (F.C.); (F.M.)
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, NICU, 20122 Milan, Italy;
| | - Maria Lorella Giannì
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy; (F.C.); (F.M.)
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, NICU, 20122 Milan, Italy;
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Kemp H, Becker P, Wenhold FAM. In-hospital Growth of Very Low Birth Weight Preterm Infants: Comparative Effectiveness of 2 Human Milk Fortifiers. J Pediatr Gastroenterol Nutr 2021; 72:610-616. [PMID: 33470753 DOI: 10.1097/mpg.0000000000003050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Amidst a high prevalence of prematurity, limited research on the growth of very low birth weight (VLBW) preterm infants and the availability of a reformulated fortifier c(RF), the study aimed to compare in-hospital growth of such infants receiving exclusively human milk fortified with either of 2 different formulations in a tertiary South African hospital. METHODS In a prospective comparative effectiveness design, intakes and growth of VLBW infants on the Original Fortifier (OF; 2016-2017) were compared with those receiving RF (2017-2018). Daily intake was calculated using published composition of preterm and mature milk with fortifier (OF: 0.2 g protein, 3.5kcal/g powder; RF: 0.4 g protein, 4.4 kcal/g powder). Change in z scores from start to end of fortification for weight (WFAZ), length (LFAZ), and head circumference (HCFAZ) for age was the primary outcome. Additionally, weight gain velocity (g · kg-1 · day-1) and gain in length and head circumference (HC) (cm/week) were calculated. RESULTS Fifty-eight infants (52% girls; gestational age: 30 ± 2 weeks; birth weight: 1215 ± 187 g) received OF for 16 days and 59 infants (56% girls; gestational age: 29 ± 2 weeks; birth weight 1202 ± 167 g) received RF for 15 days. Protein intake of RF (3.7 ± 0.4 g · kg-1 · day-1) was significantly higher (P < 0.001) than of OF (3.4 ± 0.2 g · kg-1 · day-1). Protein-to-energy ratio of RF (2.6 ± 0.2 g/100 kcal) was significantly higher (P < 0.001) than of OF (2.3 ± 0.1 g/100 kcal). In both groups, WFAZ and LFAZ decreased; HCFAZ improved slightly. No significant differences (P > 0.05) were noted between the 2 groups for change in z scores, weight gain velocity, length or HC gain. CONCLUSIONS Despite a modest increase in protein intake and protein-to-energy ratio, the growth of VLBW infants on RF was not better than on OF during their hospital stay.
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Affiliation(s)
- Hannelie Kemp
- Department of Human Nutrition, Faculty of Health Sciences
| | - Piet Becker
- Office of the Dean, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
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Zinc deficiency limiting head growth to discharge in extremely low gestational age infants with insufficient linear growth: a cohort study. J Perinatol 2020; 40:1694-1704. [PMID: 32788617 DOI: 10.1038/s41372-020-00778-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 07/14/2020] [Accepted: 08/03/2020] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To assess the relationship of size for age with zinc deficiency in extremely low gestational age (GA) infants (23-28 weeks, ELGANs) who had insufficient linear growth despite optimizing other nutrients and to analyze changes in fronto-occipital circumference (FOC), weight and length with zinc supplementation. STUDY DESIGN Retrospective cohort study. RESULTS Among 302 ELGANs, a serum zinc concentration was obtained in 52 with insufficient linear growth (17%). Zinc deficiency (serum concentration <0.74 mcg/ml) was diagnosed in 8 of 24 (33%) small for GA (SGA) compared to 35 of 278 (13%) non-SGA infants (P = 0.01). Zinc supplementation for >2 weeks improved FOC growth to discharge or 50 weeks postmenstrual age in infants with Zn deficiency. However, neither linear growth nor weight gain improved with Zn supplementation. CONCLUSION Zinc deficiency was diagnosed in 14% ELGANs in this cohort. Zinc supplementation for >2 weeks improved FOC growth but not linear growth or weight gain.
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