Linear growth patterns in small for gestational age and preterm infants after zinc supplementation

Caecilia Nancy Setiawan; Gatot Irawan Sarosa; Mexitalia Setiawati

doi:10.14238/pi55.1.2015.23-8

Caecilia Nancy Setiawan Department of Pediatrics, Diponegoro University Medical School/Dr. Kariadi Hospital, Semarang, Central Java.
Gatot Irawan Sarosa Department of Pediatrics, Diponegoro University Medical School/Dr. Kariadi Hospital, Semarang, Central Java.
Mexitalia Setiawati Department of Pediatrics, Diponegoro University Medical School/Dr. Kariadi Hospital, Semarang, Central Java.

DOI: https://doi.org/10.14238/pi55.1.2015.23-8

Keywords: small for gestational age, preterm, zinc supplementation, growth

Abstract

Background Low birth weight (LBW) infants are at risk for growth disturbances due to intrauterine zinc deficiency. Zinc supplementation is expected to improve the linear growth of LBW babies. Objective To assess the effect of zinc supplementation on linear growth in preterm and small for gestational age (SGA) infants. Methods This quasi-experimental study had a pre- and post-test design. Subjects were LBW infants hospitalized in Kariadi Hospital during March-December 2011, consisted of SGA and preterm neonates. All subjects were given 5 mg of zinc syrup daily for 3 months. Subjectsâ€™ head circumference, weight, and length were measured monthly. Serum zinc levels were measured before and after supplementation. Data were analyzed with Chi-square test, independent T-test, and general linear model repeated measure. Results A total of 61 subjects were enrolled consisted of 31 preterm and 30 SGA neonates. Mean serum zinc levels in the preterm group were 168.2 (SD 54.5) Î¼g/dL pre-supplementation and 163.6 (SD 50.7) Î¼g/dL post-supplementation (P=0.049), while mean serum zinc levels in the SGA group were 174.8 (SD 46.6) Î¼g/dL pre-supplementation and 167.4 (SD 49.4) Î¼g/dL post-supplementation (P=0.271). Median percentage preterm weight and length increased from 87.3 to 102.4% in the third month (P<0.001) and from 95.8 to 103.9% in the third month (P<0.001), respectively. Median percentage SGA weight and length increased from 73.5 to 98.3% in the third month (P<0.001) and from 94.5 to 102.2% in the third month (P<0.001), respectively. Conclusion Both, the preterm and SGA infants exhibit catch-up growth after three months of zinc supplementation. [

References

Gomella TL. Newborn physical examination. In: Gomella TL, editor. Neonatology: management, procedures, on-call problems, diseases, and drugs. 6th ed. New York: McGraw-Hill Companies; 2009. p. 31-42.

Sur D, Gupta DN, Mondal SK, Ghosh S, Manna B, Rajendran K, et al. Impact of zinc supplementation on diarrheal morbidity and growth pattern of low birth weight infants in Kolkata, India: a randomized, double-blind, placebo-controlled, community-based study. Pediatrics. 2003;112:1327-32.

Franko KL, Gluckman PD, Law CM, BeedLe AS, Morton SMB. Low birth weight and optimal fetal development: a global perspective. In: Kiess W, Chernausk SD, HokkenKoelega ACS, editors. Small for gestational age: causes and consequences. Pediatr Adolesc Med. vol 13. Basel: Karger; 2009. p. 73-85.

Hambidge KM, Krebs NF. Zinc deficiency: a special challenge. J Nutr. 2007;137:1101-5.

International Zinc Nutrition Consultative Group (IZiNCG), Brown KH, Rivera JA, Bhutta Z, Gibson RS, King JC, et al. International Zinc Nutrition Consultative Group (IZiNCG) technical document #1. Assessment of the risk of zinc deficiency in populations and options for its control. Food Nutr Bull. 2004;25:S99-203.

Dijkhuizen MA, Wieringa FT, West CE, Martuti S, Muhilal. Effects of iron and zinc supplementation in Indonesian infants on micronutrient status and growth. J Nutr. 2001;131:2860â€“5.

Sharda B, Adhikari R, Ajmera M, Gambhir R, Singh PP. Zinc and copper in preterm neonates: relationship with breast milk. Indian J Pediatr. 1999;66:685-95.

Diaz-Gomez NM, Domenech E, Barroso F, Castells S, Cortabarria C, Jimenez A. The effect of zinc supplementation on linear growth, body composition, and growth factors in preterm infants. Pediatrics. 2003;111:1002-9.

Islam MN, Ullah MW, Siddika M, Qurishi SB, Hossain MA, Choudhury MA, et al. Serum zinc level in preterm low birth weight babies and its comparison between preterm AGA and preterm SGA babies. Mymensingh Med J. 2008;17:145-8.

Fenton TR. A new growth chart for preterm babies: Babson and Bendaâ€™s chart updated with recent data and a new format. BMC Pediatr. 2003;3:13.

King JC, Shames DM, Woodhouse LR. Zinc homeostasis in humans. J Nutr. 2000;130:1360S-6S.

Dorea JG. Zinc deficiency in nursing infants. J Am Coll Nutr. 2002;21:84-7.

Zlotkin S. Special micronutrient concerns in premature infants: implications for enteral and parenteral feeding. In: Delange FM, West KP, editors. Micronutrient deficiencies in the first months of life. Nestle Nutrition Workshop Series Pediatric Program, vol. 52. Basel: Karger; 2003. p. 231-44.

Walker CL, Bhutta ZA, Bhandari N, Teka T, Shahid F, Taneja S, et al. Zinc during and in convalescence from diarrhea has no demonstrable effect on subsequent morbidity and anthropometric status among infants <6 mo of age. Am J Clin Nutr. 2007;85:887-94.