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Ito T, Uenoyama K, Kobayashi K, Kakumoto M, Mizumoto H, Katsura T, Onoue M. [Decreased Serum Copper Concentrations by Zinc Administration in Preterm Infants with Hypozincemia Are Associated with a Lower Postmenstrual Age: A Single-center Retrospective Observational Study]. YAKUGAKU ZASSHI 2022; 142:999-1004. [PMID: 36047227 DOI: 10.1248/yakushi.22-00083] [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: 11/22/2022]
Abstract
Copper is one of the essential trace elements in humans, and its deficiency causes various diseases. Zinc acetate dihydrate is administered to treat hypozincemia in preterm infants; however, zinc inhibits the gastrointestinal absorption of copper, which may cause copper deficiency. To safely treat hypozincemia in preterm infants, we retrospectively analyzed the factors reducing serum copper concentrations when zinc is administered to preterm infants with hypozincemia. Seventy preterm infants were included in the present study. Serum zinc and copper concentrations, doses, and other clinical characteristics were retrieved from electronic medical records. The administration of zinc acetate dihydrate decreased serum copper concentrations in 21 out of 70 patients. In comparisons between the two groups with and without a decrease in serum copper concentrations, significant differences were observed in postmenstrual age (34.9 and 35.9 weeks, respectively) and serum zinc concentrations (62.0 and 58.0 μg/dL, respectively) at the start of the zinc acetate dihydrate treatment. A logistic regression analysis identified postmenstrual age as a significant factor decreasing serum copper concentrations. In the ROC curve, the cut-off value for postmenstrual age for a decrease in serum copper concentrations was 34.143 weeks. The present results suggest that when zinc acetate dihydrate is administered to preterm infants with a low postmenstrual age who are at higher risk of decreased serum copper concentrations, particularly to those with a postmenstrual age <34 weeks, it is important to consider copper deficiency and periodically measure serum copper concentrations.
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Affiliation(s)
- Toshikazu Ito
- Department of Pharmacy, Kitano Hospital, Tazuke Kofukai Medical Research Institute.,Laboratory of Clinical Pharmaceutics and Therapeutics, College of Pharmaceutical Sciences, Ritsumeikan University
| | - Kazuya Uenoyama
- Department of Pharmacy, Kitano Hospital, Tazuke Kofukai Medical Research Institute
| | - Kazuhiro Kobayashi
- Department of Pharmacy, Kitano Hospital, Tazuke Kofukai Medical Research Institute
| | - Mikio Kakumoto
- Laboratory of Clinical Pharmacy 2, College of Pharmaceutical Sciences, Ritsumeikan University
| | - Hiroshi Mizumoto
- Department of Pediatrics, Kitano Hospital, Tazuke Kofukai Medical Research Institute
| | - Toshiya Katsura
- Laboratory of Clinical Pharmaceutics and Therapeutics, College of Pharmaceutical Sciences, Ritsumeikan University
| | - Masahide Onoue
- Department of Pharmacy, Kitano Hospital, Tazuke Kofukai Medical Research Institute
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Alshaikh B, Abo Zeed M, Yusuf K, Guin M, Fenton T. Effect of enteral zinc supplementation on growth and neurodevelopment of preterm infants: a systematic review and meta-analysis. J Perinatol 2022; 42:430-439. [PMID: 34006967 DOI: 10.1038/s41372-021-01094-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 03/29/2021] [Accepted: 04/30/2021] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To evaluate effect of enteral zinc supplementation on growth and neurodevelopmental outcomes of preterm infants. STUDY DESIGN A systematic review and meta-analysis of randomized-controlled trials (RCTs) examining growth and neurodevelopmental outcomes after zinc supplementation in preterm infants. RESULTS Of eight RCTs involving 742 infants included, seven reported growth anthropometrics at 3-6 months corrected age (CA) and two reported neurodevelopmental outcomes at 6-12 months CA. Zinc supplementation was associated with increased weight z-score (weighted mean difference (WMD) = 0.50; 95% CI 0.23-0.76, heterogeneity I2 = 89.1%; P < 0.01), length z-score (WMD = 1.12; 95% CI 0.63-1.61, heterogeneity I2 = 96.0%; P < 0.01) and motor developmental score (WMD = 9.54; 95% CI 6.6-12.4 heterogeneity I2 = 0%; P = 0.52). There was no effect on head circumference and total developmental score. Evidence is "moderate" certainty for weight and length and "very low" certainty for neurodevelopment. CONCLUSION Zinc supplementation may enhance weight gain and linear growth in preterm infants. There is a lack of data about relationship between zinc supplementation and neurodevelopment.
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Affiliation(s)
- Belal Alshaikh
- Neonatal Nutrition and Gastroenterology Program, University of Calgary, Calgary, AB, Canada.
- Community Health Sciences, Institute of Public Health, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
| | | | - Kamran Yusuf
- Neonatal Nutrition and Gastroenterology Program, University of Calgary, Calgary, AB, Canada
| | - Madhusudan Guin
- Neonatal Nutrition and Gastroenterology Program, University of Calgary, Calgary, AB, Canada
| | - Tanis Fenton
- Community Health Sciences, Institute of Public Health, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Nutrition Services, Alberta Health Services, Calgary, AB, Canada
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Kumari D, Garg S, Bhawrani P. Zinc homeostasis in immunity and its association with preterm births. Scand J Immunol 2022; 95:e13142. [PMID: 35007353 DOI: 10.1111/sji.13142] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 12/27/2021] [Accepted: 01/06/2022] [Indexed: 11/27/2022]
Abstract
Preterm birth is among the most common adverse pregnancy outcomes and is the leading cause of neonatal mortality and morbidity. While trace elements are essential for humans, their specific roles in the prenatal period remain unexplored. Zinc, a ubiquitous element plays a pivotal role in protein synthesis, cell division, nucleic acid metabolism, apoptosis, ageing, reproduction, immunological as well as antioxidant defense mechanism. Although zinc quantities are very small in body tissue, it is involved in every conceivable biochemical pathway which is critical for the performance of various functions necessary to sustain life. Owing to the multifactorial role of zinc, it is not possible to attribute a certain zinc dependent mechanism in pre-term births. Although the effect of zinc deficiency on immunity, its impact on maternal function and health as well as its role in the developing foetus is well documented, much less attention has been given to the understanding of micronutrient zinc homeostasis in immunity and its association with preterm births. Despite extensive research, the pathway by which zinc regulates pregnancy outcomes as well as the function of immune cells in controlling the delivery status (term/ preterm) is still obscure. The present review aims to focus on the understanding of relationship of micronutrient zinc homeostasis in immunity and its association with preterm births.
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Affiliation(s)
- Deepa Kumari
- Department of Obstetrics and Gynecology, Mahatma Gandhi University of Medical Science & Technology, Jaipur, Rajasthan- 302022
| | - Swati Garg
- Department of Obstetrics and Gynecology, Mahatma Gandhi University of Medical Science & Technology, Jaipur, Rajasthan- 302022
| | - Priyanka Bhawrani
- ICMR Project, Mahatma Gandhi University of Medical Science & Technology, Jaipur, Rajasthan- 302022
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Ito T, Uenoyama K, Kobayashi K, Kakumoto M, Mizumoto H, Katsura T, Onoue M. Administration of zinc to preterm infants with hypozincemia does not reduce serum copper concentrations in most cases: a single-center retrospective observational study. J Pharm Health Care Sci 2021; 7:46. [PMID: 34852847 PMCID: PMC8638113 DOI: 10.1186/s40780-021-00229-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 10/19/2021] [Indexed: 12/01/2022] Open
Abstract
Background Zinc is an essential trace element involved in various physiological functions. In Japan, zinc acetate dihydrate is administered to neonates and infants with hypozincemia. Since serum copper concentrations are reduced by the administration of zinc, we retrospectively investigated changes in serum zinc and copper concentrations in preterm infants with hypozincemia receiving zinc acetate dihydrate. Methods Sixty-three preterm infants were included in the present study. Serum zinc and copper concentrations, doses, and other clinical characteristics were retrieved from electronic medical records. Results The medians and interquartile ranges of the dosage and duration of zinc acetate dihydrate were 2.1 (1.8–2.5) mg/kg/day and 12.0 (10.0–13.0) days, respectively. Its administration increased serum zinc concentrations in 39 patients (61.9%) and to more than 70 μg/dL in 16 patients (25.4%). The group with a serum zinc concentration of 70 μg/dL or higher after administration had a significantly higher zinc dose of 2.5 mg/kg/day than the group with a serum zinc concentration of less than 70 μg/dL. Serum copper concentrations did not decrease in 44 patients (69.8%). In the group with a decreased serum copper concentration, postmenstrual age and body weight were significantly lower, while serum zinc concentrations were significantly higher at the start of administration. Conclusion The present results showed that when zinc acetate dihydrate was administered to preterm infants with hypozincemia, it was possible to increase serum zinc concentrations without decreasing serum copper concentrations in many cases. However, caution may be required when administering zinc to preterm infants with a lower postmenstrual age or milder hypozincemia because serum copper concentrations may decrease.
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Affiliation(s)
- Toshikazu Ito
- Department of Pharmacy, Kitano Hospital, Tazuke Kofukai Medical Research Institute. 2-4-20, Ogimachi, Kita-ku, Osaka, 530-8480, Japan. .,Laboratory of Clinical Pharmaceutics and Therapeutics, College of Pharmaceutical Sciences, Ritsumeikan University, 1-1-1, Noji-higashi, Kusatsu, Shiga, 525-8577, Japan.
| | - Kazuya Uenoyama
- Department of Pharmacy, Kitano Hospital, Tazuke Kofukai Medical Research Institute. 2-4-20, Ogimachi, Kita-ku, Osaka, 530-8480, Japan
| | - Kazuhiro Kobayashi
- Department of Pharmacy, Kitano Hospital, Tazuke Kofukai Medical Research Institute. 2-4-20, Ogimachi, Kita-ku, Osaka, 530-8480, Japan
| | - Mikio Kakumoto
- Laboratory of Clinical Pharmacy, College of Pharmaceutical Sciences, Ritsumeikan University, 1-1-1, Noji-higashi, Kusatsu, Shiga, 525-8577, Japan
| | - Hiroshi Mizumoto
- Department of Pediatrics, Kitano Hospital, Tazuke Kofukai Medical Research Institute, 2-4-20, Ogimachi, Kita-ku, Osaka, 530-8480, Japan
| | - Toshiya Katsura
- Laboratory of Clinical Pharmaceutics and Therapeutics, College of Pharmaceutical Sciences, Ritsumeikan University, 1-1-1, Noji-higashi, Kusatsu, Shiga, 525-8577, Japan
| | - Masahide Onoue
- Department of Pharmacy, Kitano Hospital, Tazuke Kofukai Medical Research Institute. 2-4-20, Ogimachi, Kita-ku, Osaka, 530-8480, Japan
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Staub E, Evers K, Askie LM. Enteral zinc supplementation for prevention of morbidity and mortality in preterm neonates. Cochrane Database Syst Rev 2021; 3:CD012797. [PMID: 33710626 PMCID: PMC8092450 DOI: 10.1002/14651858.cd012797.pub2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Preterm and low birth weight infants are born with low stores in zinc, which is a vital trace element for growth, cell differentiation and immune function. Preterm infants are at risk of zinc deficiency during the postnatal period of rapid growth. Systematic reviews in the older paediatric population have previously shown that zinc supplementation potentially improves growth and positively influences the course of infectious diseases. In paediatric reviews, the effect of zinc supplementation was most pronounced in those with low nutritional status, which is why the intervention could also benefit preterm infants typically born with low zinc stores and decreased immunity. OBJECTIVES To determine whether enteral zinc supplementation, compared with placebo or no supplementation, affects important outcomes in preterm infants, including death, neurodevelopment, common morbidities and growth. SEARCH METHODS Our searches are up-to-date to 20 February 2020. For the first search, we used the standard search strategy of Cochrane Neonatal to search the Cochrane Central Register of Controlled Trials (CENTRAL 2017, Issue 8), MEDLINE via PubMed (1966 to 29 September 2017), Embase (1980 to 29 September 2017), and CINAHL (1982 to 29 September 2017). We also searched clinical trials databases, conference proceedings, and the reference lists of retrieved articles for randomised controlled trials (RCTs) and quasi-RCTs. We ran an updated search from 1 January 2017 to 20 February 2020 in the following databases: CENTRAL via CRS Web, MEDLINE via Ovid, and CINAHL via EBSCOhost. SELECTION CRITERIA We included RCTs and quasi-RCTs that compared enteral zinc supplementation versus placebo or no supplementation in preterm infants (gestational age < 37 weeks), and low birth weight babies (birth weight < 2500 grams), at any time during their hospital admission after birth. We included zinc supplementation in any formulation, regimen, or dose administered via the enteral route. We excluded infants who underwent gastrointestinal (GI) surgery during their initial hospital stay, or had a GI malformation or another condition accompanied by abnormal losses of GI juices, which contain high levels of zinc (including, but not limited to, stomas, fistulas, and malabsorptive diarrhoea). DATA COLLECTION AND ANALYSIS We used the standard methods of Cochrane Neonatal. Two review authors separately screened abstracts, evaluated trial quality and extracted data. We synthesised effect estimates using risk ratios (RR), risk differences (RD), and standardised mean differences (SMD). Our primary outcomes of interest were all-cause mortality and neurodevelopmental disability. We used the GRADE approach to assess the certainty of evidence. MAIN RESULTS We included five trials with a total of 482 preterm infants; there was one ongoing trial. The five included trials were generally small, but of good methodological quality. Enteral zinc supplementation compared to no zinc supplementation Enteral zinc supplementation started in hospitalised preterm infants may decrease all-cause mortality (between start of intervention and end of follow-up period) (RR 0.55, 95% CI 0.31 to 0.97; 3 studies, 345 infants; low-certainty evidence). No data were available on long-term neurodevelopmental outcomes at 18 to 24 months of (post-term) age. Enteral zinc supplementation may have little or no effect on common morbidities such as bronchopulmonary dysplasia (RR 0.66, 95% CI 0.31 to 1.40, 1 study, 193 infants; low-certainty evidence), retinopathy of prematurity (RR 0.14, 95% CI 0.01 to 2.70, 1 study, 193 infants; low-certainty evidence), bacterial sepsis (RR 1.11, 95% CI 0.60 to 2.04, 2 studies, 293 infants; moderate-certainty evidence), or necrotising enterocolitis (RR 0.08, 95% CI 0.00 to 1.33, 1 study, 193 infants; low-certainty evidence). The intervention probably improves weight gain (SMD 0.46, 95% CI 0.28 to 0.64; 5 studies, 481 infants; moderate-certainty evidence); and may slightly improve linear growth (SMD 0.75, 95% CI 0.36 to 1.14, 3 studies, 289 infants; low-certainty evidence), but may have little or no effect on head growth (SMD 0.21, 95% CI -0.02 to 0.44, 3 studies, 289 infants; moderate-certainty evidence). AUTHORS' CONCLUSIONS Enteral supplementation of zinc in preterm infants compared to no supplementation or placebo may moderately decrease mortality and probably improve short-term weight gain and linear growth, but may have little or no effect on common morbidities of prematurity. There are no data to assess the effect of zinc supplementation on long-term neurodevelopment.
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Affiliation(s)
- Eveline Staub
- Department of Neonatology, Royal North Shore Hospital, St Leonards, Australia
| | - Katrina Evers
- University of Basel Children's Hospital (UKBB), Basel, Switzerland
| | - Lisa M Askie
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, Australia
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Vázquez-Gomis R, Bosch-Gimenez V, Juste-Ruiz M, Vázquez-Gomis C, Izquierdo-Fos I, Pastor-Rosado J. Zinc concentration in preterm newborns at term age, a prospective observational study. BMJ Paediatr Open 2019; 3:e000527. [PMID: 31646195 PMCID: PMC6782045 DOI: 10.1136/bmjpo-2019-000527] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 08/26/2019] [Accepted: 08/27/2019] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES To determine zinc concentrations and associated factors in a population of preterm newborns at term age. DESIGN This analytical, descriptive, observational and prospective study was conducted in the neonatal unit of a tertiary hospital. Preterm newborn between gestational weeks 24 and 34 were included in the study. The patients were recruited close to the date of birth. Their clinical histories were collected, and the serum zinc concentrations (SZCs) at gestational weeks 37-41 were measured. This study aimed to measure SZC in a population of preterm newborns at term age, and analyse the anthropometric, clinical and nutritional parameters associated with a decrease in SZC. RESULTS Overall, 83 preterm subjects were evaluated, including 44 (53%) female infants and 39 (47%) male infants. The median period of gestation was 31 (IQ25-IQ75: 29-33) weeks, and the mean weight at birth was 1.523±0.535 kg. The median SZC at term was 4.4 (IQ25-IQ75: 2.6-6.9) µmol/L. There were some variables associated with zinc concentrations like bronchopulmonary dysplasia (BPD), weight at birth, z-score of length at discharge, being small for gestational age and treatment with recombinant human erythropoietin, although the unique variable that was independent of the other variables in the multivariate analysis (p 0.01) was BPD. Preterm newborn with BPD had lower SZC at term age than those without (2.7 vs 4.9 µmol/L, p 0.005). CONCLUSIONS Zinc concentrations in this preterm population were low. BPD was significantly and negatively correlated with zinc concentrations. CLINICAL TRIAL REGISTRATION NCT03532555.
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Affiliation(s)
| | | | - Mercedes Juste-Ruiz
- Pediatrics, Hospital Universitario de San Juan de Alicante, Sant Joan d'Alacant, Spain
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Kodama H. [Recent Trends of Trace Element Studies in Clinical Medicine in Japan]. Nihon Eiseigaku Zasshi 2018; 73:75-82. [PMID: 29386451 DOI: 10.1265/jjh.73.75] [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: 11/09/2022]
Abstract
The deficiency or excess intake of trace elements, including zinc, copper, selenium and iodine, has often been reported. Zinc deficiency is often observed in infants fed breast milk with low zinc concentration, individuals administered chelating medicines, athletes and patients with diabetes mellitus, hepatic cirrhosis or nephrosis syndrome. Menkes disease is associated with severe copper deficiency, and there is no effective treatment. Deficiencies of selenium and iodine are observed in patients who receive special formulas of milk and enteral formula with low selenium and iodine concentrations, respectively. In contrast, neonatal transient hypothyroidism due to excess intake of iodine in pregnant women has also reported in Japan. It is expected that collaborative studies by researchers and clinicians will contribute to clarify the detail mechanism, diagnosis and treatment of these abnormalities.
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Affiliation(s)
- Hiroko Kodama
- Department of Health and Dietetics, Faculty of Health and Medical Sciences, Teikyo Heisei University
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Staub E, Evers K, Askie LM. Enteral zinc supplementation for prevention of morbidity and mortality in preterm neonates. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2017. [DOI: 10.1002/14651858.cd012797] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Eveline Staub
- Royal North Shore Hospital; Department of Neonatology; Reserve Road St Leonards NSW Australia
| | - Katrina Evers
- University of Basel Children's Hospital (UKBB); Basel Switzerland
| | - Lisa M Askie
- University of Sydney; NHMRC Clinical Trials Centre; Locked Bag 77 Camperdown NSW Australia 2050
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Bocca B, Ciccarelli S, Agostino R, Alimonti A. Trace elements, oxidative status and antioxidant capacity as biomarkers in very low birth weight infants. ENVIRONMENTAL RESEARCH 2017; 156:705-713. [PMID: 28478178 DOI: 10.1016/j.envres.2017.04.027] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 03/01/2017] [Accepted: 04/21/2017] [Indexed: 06/07/2023]
Abstract
Reference data on trace elements, oxidative status and antioxidants in very low birth weight infants (VLBW) are limited and need to be updated for use in clinical settings. Serum and urine of 30 VLBW infants (mean weight, 1167g) at mean age of 23.8 (t0) and 37.8 (t1) days were analyzed. Cadmium (Cd), copper (Cu), iron (Fe), mercury (Hg), manganese (Mn), selenium (Se) and zinc (Zn), nitrate/nitrite (NOx), catalase (CAT), CuZnFeMn-superoxide dismutases (CuZnFeMn-SODs), total antioxidant capacity (SAC: sum of thiols, proteins, bilirubin, uric acid, β-beta-carotene, ascorbic acid, vitamin E) and total oxidative status (SOS: sum of lipo- and hydroperoxides) were determined. A higher urinary excretion of Cu and Zn was observed at t0 than at t1; while an increase in urine Cd was found at t1 respect to t0. A deficiency in serum levels of Cu and Zn was also found. A lower CAT activity, a higher total oxidants level (SOS) and a reduction of total antioxidant barriers (SAC) were observed in some infants. No Fe and Mn deficiency or Hg overload was found; also CuZnFeMn-SODs and NOx levels did not change. The findings showed that losses of trace elements and incomplete mineral body stores were more pronounced in the earlier life stage (at 23.8th day) than later on; moreover, antioxidant defenses were poor and lipo- and hydroperoxides were higher still at 5 weeks of infants' life.
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Affiliation(s)
- Beatrice Bocca
- Department of Environment and Health, Istituto Superiore di Sanità, Rome, Italy.
| | - Simona Ciccarelli
- Neonatal Intensive Care Unit and Neonatal Pathology, S. Giovanni Calibita-Fatebenefratelli Hospital, Rome, Italy
| | - Rocco Agostino
- Member of Etic Committee, Bambino Gesù Paediatric Hospital, Rome, Italy
| | - Alessandro Alimonti
- Department of Environment and Health, Istituto Superiore di Sanità, Rome, Italy
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Fernández-Menéndez S, Fernández-Sánchez ML, Fernández-Colomer B, de la Flor St. Remy RR, Cotallo GDC, Freire AS, Braz BF, Santelli RE, Sanz-Medel A. Total zinc quantification by inductively coupled plasma-mass spectrometry and its speciation by size exclusion chromatography–inductively coupled plasma-mass spectrometry in human milk and commercial formulas: Importance in infant nutrition. J Chromatogr A 2016; 1428:246-54. [DOI: 10.1016/j.chroma.2015.09.021] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 09/03/2015] [Accepted: 09/07/2015] [Indexed: 10/23/2022]
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Terrin G, Berni Canani R, Di Chiara M, Pietravalle A, Aleandri V, Conte F, De Curtis M. Zinc in Early Life: A Key Element in the Fetus and Preterm Neonate. Nutrients 2015; 7:10427-46. [PMID: 26690476 PMCID: PMC4690094 DOI: 10.3390/nu7125542] [Citation(s) in RCA: 111] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Revised: 11/23/2015] [Accepted: 11/26/2015] [Indexed: 11/26/2022] Open
Abstract
Zinc is a key element for growth and development. In this narrative review, we focus on the role of dietary zinc in early life (including embryo, fetus and preterm neonate), analyzing consequences of zinc deficiency and adequacy of current recommendations on dietary zinc. We performed a systematic search of articles on the role of zinc in early life. We selected and analyzed 81 studies. Results of this analysis showed that preservation of zinc balance is of critical importance for the avoidance of possible consequences of low zinc levels on pre- and post-natal life. Insufficient quantities of zinc during embryogenesis may influence the final phenotype of all organs. Maternal zinc restriction during pregnancy influences fetal growth, while adequate zinc supplementation during pregnancy may result in a reduction of the risk of preterm birth. Preterm neonates are at particular risk to develop zinc deficiency due to a combination of different factors: (i) low body stores due to reduced time for placental transfer of zinc; (ii) increased endogenous losses; and (iii) marginal intake. Early diagnosis of zinc deficiency, through the measurement of serum zinc concentrations, may be essential to avoid severe prenatal and postnatal consequences in these patients. Typical clinical manifestations of zinc deficiency are growth impairment and dermatitis. Increasing data suggest that moderate zinc deficiency may have significant subclinical effects, increasing the risk of several complications typical of preterm neonates (i.e., necrotizing enterocolitis, chronic lung disease, and retinopathy), and that current recommended intakes should be revised to meet zinc requirements of extremely preterm neonates. Future studies evaluating the adequacy of current recommendations are advocated.
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Affiliation(s)
- Gianluca Terrin
- Department of Gynecology-Obstetrics, University of Rome La Sapienza, Rome 00186, Italy.
| | - Roberto Berni Canani
- Department of Translational Medicine, University of Naples Federico II, Napoli 80138, Italy.
| | - Maria Di Chiara
- Department of Gynecology-Obstetrics, University of Rome La Sapienza, Rome 00186, Italy.
| | - Andrea Pietravalle
- Department of Gynecology-Obstetrics, University of Rome La Sapienza, Rome 00186, Italy.
| | - Vincenzo Aleandri
- Department of Gynecology-Obstetrics, University of Rome La Sapienza, Rome 00186, Italy.
- Research Center on Evaluation of Quality in Medicine-CEQUAM, University of Rome La Sapienza, Rome 00186, Italy.
| | - Francesca Conte
- Department of Pediatrics, University of Rome La Sapienza, Rome 00186, Italy.
| | - Mario De Curtis
- Department of Pediatrics, University of Rome La Sapienza, Rome 00186, Italy.
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Burjonrappa SC, Miller M. Role of trace elements in parenteral nutrition support of the surgical neonate. J Pediatr Surg 2012; 47:760-71. [PMID: 22498394 DOI: 10.1016/j.jpedsurg.2012.01.015] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2011] [Revised: 01/11/2012] [Accepted: 01/11/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Parenteral nutrition (PN) has transformed the outcome for neonates with surgical problems in the intensive care unit. Trace element supplementation in PN is a standard practice in many neonatal intensive care units. However, many of these elements are contaminants in PN solutions, and contamination levels may, in themselves, be sufficient for normal metabolic needs. Additional supplementation may actually lead to toxicity in neonates whose requirements are small. METHODS An electronic search of the MEDLINE, Cochrane Collaboration, and SCOPUS English language medical databases was performed for the key words "trace elements," "micro-nutrients," and "parenteral nutrition additives." Studies were categorized based on levels of evidence offered, with randomized controlled trials and meta-analyses accorded the greatest importance at the apex of the data pool and case reports and animal experiments the least importance. Articles were reviewed with the primary goal of developing uniform recommendations for trace element supplementation in the surgical neonate. The secondary goals were to review the physiologic role, metabolic demands, requirements, losses, deficiency syndromes, and toxicity symptoms associated with zinc, copper, chromium, selenium, manganese, and molybdenum supplementation in PN. RESULTS Zinc supplementation must begin at initiation of PN. All other trace elements can be added to PN 2 to 4 weeks after initiation. Copper and manganese need to be withheld if the neonate develops PN-associated liver disease. The status of chromium supplementation is currently being actively debated, with contaminant levels in PN being sufficient in most cases to meet neonatal requirements. Selenium is an important component of antioxidant enzymes with a role in the pathogenesis of neonatal surgical conditions such as necrotizing enterocolitis and bronchopulmonary dysplasia. Premature infants are often selenium deficient, and early supplementation has shown a reduction in sepsis events in this age group. CONCLUSION Appropriate supplementation of trace elements in surgical infants is important, and levels should be monitored. In certain settings, it may be more appropriate to individualize trace element supplementation based on the predetermined physiologic need rather than using bundled packages of trace elements as is the current norm. Balance studies of trace element requirements should be performed to better establish clinical recommendations for optimal trace element dosing in the neonatal surgical population.
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Affiliation(s)
- Sathyaprasad C Burjonrappa
- Department of Nutrition and Pediatrics, Maimonides Infants and Children's Hospital, Brooklyn, NY 11219, USA.
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Loui A, Raab A, Maier RF, Brätter P, Obladen M. Trace elements and antioxidant enzymes in extremely low birthweight infants. J Trace Elem Med Biol 2010; 24:111-8. [PMID: 20413069 DOI: 10.1016/j.jtemb.2009.11.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2009] [Revised: 10/15/2009] [Accepted: 11/13/2009] [Indexed: 01/13/2023]
Abstract
Oxygen radicals are believed to contribute to typical diseases of prematurity, such as bronchopulmonary dysplasia (BPD), intraventricular haemorrhage (IVH), retinopathy of prematurity (ROP) and necrotising enterocolitis (NEC). Our aim was to investigate whether these disorders are associated with disturbances in antioxidant enzyme activities and with low trace elements, which are co-factors of antioxidant enzymes. 209 infants with birthweight less than 1000g were enrolled into a European multicentre randomised erythropoietin (rhEPO) trial; 155 developed one or more of the above mentioned diseases. We analysed Zn, Cu, Fe, Se in plasma and red blood cells (RBCs), superoxide dismutase (CuZn-SOD), glutathione peroxidase (GSH-Px), and catalase (CAT) in RBCs on the 3rd and 68th day of life. Zn, Fe, Se in plasma, and Se in RBCs decreased (p<0.01), and Zn in RBC (p<0.001), CuZn-SOD (p<0.01) and CAT increased (p<0.05), whereas GSH-Px remained unchanged. No differences were observed between the rhEPO and control groups. Antioxidant enzyme activities did not correlate with gestational age. In infants with BPD, IVH, ROP, or NEC, CuZn-SOD and CAT (p<0.05) were higher at day 68 than in infants without these diseases. CuZn-SOD and GSH-Px at 3 days and CuZn-SOD at 68 days correlated positively (p<0.05) with the duration of oxygen treatment. In conclusion, in ELBW infants, trace element concentrations decreased over the first 10 weeks of life. Lower trace element concentrations, did not affect the activities of CuZn-SOD, GSH-Px, and CAT. Typical diseases of prematurity were not associated with decreased antioxidant enzyme activities.
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Affiliation(s)
- Andrea Loui
- Department of Neonatology, Charité Virchow Hospital, Humboldt University Berlin, Germany.
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Effect of oral zinc supplementation on the growth of preterm infants. Indian Pediatr 2010; 47:845-9. [PMID: 20308765 DOI: 10.1007/s13312-010-0145-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2009] [Accepted: 11/05/2009] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To compare the effect of oral zinc supplementation on growth of preterm infants. DESIGN Randomized controlled trial. SETTING Dhaka Shisu Hospital (Tertiary care hospital). SUBJECTS 100 appropriate for date preterm infants weighing between 1000 to 2500 g were randomized to receive zinc and multivitamin supplement (Group I; n=50) or only multivitamin supplement (Group II). INTERVENTION Zinc supplementation was given 2mg/kg/day for 6 weeks along with multivitamin in Group I and only multivitamin to Group II. PRIMARY OUTCOME VARIABLE Increment of weight and length. RESULTS At enrollment, serum zinc (62.1 ± 12.4 ug/dL in Group I and 63.1 ± 14.6 ug/dL in Group II) and hemoglobin levels (14.9 ± 2.4 g/dL in Group I and 14.4 ± 1.7 g/dL in Group II) were almost similar in both groups. Serum zinc levels were in lower limit of normal range. After supplementation, serum zinc and hemoglobin levels were significantly higher in Group I (105 ± 16.5 ug/dL) than Group II (82.2 ± 17.4 ug/dL) (P<0.05). Weight, length and head circumference were comparable in both groups at enrollment. Significant differences in weight gain and increment in length were found in first and second follow up between two groups but OFC increments were not significant (P>0.05). Reduction of morbidity was apparent in zinc supplemented group. No serious adverse effect was noted related to supplementation therapy. CONCLUSION Zinc supplementation for preterm low birth weight babies is found effective to enhance the growth in early months of life.
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