Zinc supplementation in preterm infants and growth indicators  in a developing country

Risma Kerina Kaban; Henri Azis; Titis Prawitasari; Ahmad Kautsar; Setya Dewi Lusyati; Nadia Dwi Insani

doi:10.14238/pi63.6.2023.443-9

Risma Kerina Kaban Department of Child Health, University of Indonesia Medical School/Dr. Cipto Mangunkusumo Hospital, Jakarta
Henri Azis HM Rabain Hospital, Muara Enim Regency, South Sumatra
Titis Prawitasari Department of Child Health, Faculty of Medicine, Universitas Indonesia/Dr. Cipto Mangunkusumo General Hospital, Jakarta
Ahmad Kautsar Department of Child Health, Faculty of Medicine, Universitas Indonesia/Dr. Cipto Mangunkusumo General Hospital, Jakarta
Setya Dewi Lusyati National Center for Women and Children’s Health Harapan Kita, Jakarta
Nadia Dwi Insani Fatmawati Central General Hospital, Jakarta

DOI: https://doi.org/10.14238/pi63.6.2023.443-9

Keywords: zinc; preterm infant; growth indicators

Abstract

Background Zinc is one of the micronutrients that is found deficient in preterm infants. To date, no parenteral zinc supplements are available in Indonesia and there is no recommendation established for routine zinc supplementation in preterm infants.

Objective To evaluate the impact of zinc supplementation on growth indicators and morbidity in preterm infants.

Methods This double-blind, randomized controlled trial included preterm infants aged 28-32 weeks who were assigned to one of two groups: the first group received a 10 mg zinc supplementation, while the second (control) group received a placebo. At discharge or at a maximum of 40 weeks post-menstrual age (PMA, calculated from the first day of the mother's last menstrual period), the following were evaluated : growth indicators (weight, length, and head circumference), serum zinc level, zinc supplementation side effects, and morbidity rate (intraventricular hemorrhage/IVH, necrotizing enterocolitis/NEC, btonchopulmonary dysplasia/BPD). Data were analyzed with independent T-test using SPSS version 22 software.

Results Seventy-eight subjects were assigned to the zinc supplementation group and 76 subjects were assigned to the placebo group. Serum zinc level and mean body weight increment were significantly higher in the zinc group compared to the placebo group (P=0.00 and P=0.02, respectively). There were no significant differences between groups in mean body length or head circumference increment, nor in morbidity rate.

Conclusion Preterm infants who received zinc supplementation have higher serum zinc level and mean body weight increment compared to the placebo group. No side effects are observed to have been caused by zinc supplementation.

References

1. King JC. Zinc: an essential but elusive nutrient. Am J Clin Nutr. 2011;94:679S-84S. DOI: https://doi.org/10.3945/ajcn.110.005744.
2. Vallee BL, Auld DS. Zinc coordination, function, and structure of zinc enzymes and other proteins. Biochemistry. 1990;29:5647-59. DOI: https://doi.org/10.1021/BI00476A001
3. MacDonald RS. The role of zinc in growth and cell proliferation. J Nutr. 2000;130:1500S-8S. DOI: https://doi.org/ 10.1093/JN/130.5.1500S
4. Prasad AS. Zinc in human health: effect of zinc on immune cells. Mol Med. 2008;14:353-7. DOI: https://doi.org/10.2119/2008-00033.Prasad
5. Fukada T, Yamasaki S, Nishida K, Murakami M, Hirano T. Zinc homeostasis and signaling in health and diseases: zinc signaling. J Biol Inorg Chem. 2011;16:1123-34. DOI: https://doi.org/ 10.1007/S00775-011-0797-4
6. Terrin G, Berni Canani R, Passariello A, Messina F, Conti MG, Caoci S, et al. Zinc supplementation reduces morbidity and mortality in very-low-birth-weight preterm neonates: a hospital-based randomized, placebo-controlled trial in an industrialized country. Am J Clin Nutr. 2013;98:1468-74. DOI: https://doi.org/10.3945/AJCN.112.054478
7. Wastney ME, Angelus PA, Barnes RM, Subramanian KN. Zinc absorption, distribution, excretion, and retention by healthy preterm infants. Pediatr Res. 1999;45:191–6. DOI: https://doi.org/ 10.1203/00006450-199902000-00006
8. Uriu-Adams JY, Keen CL. Zinc and reproduction: effects of zinc deficiency on prenatal and early postnatal development. Birth Defects Res B Dev Reprod Toxicol. 2010;89:313-25. DOI: https://doi.org/10.1002/bdrb.20264
9. Kaban RK, Dharmasetiawani N, Siswanto JE. Prevalens dan faktor risiko terjadinya hipozincemia bayi berat lahir rendah pada usia koreksi mendekati cukup bulan atau cukup bulan. Sari Pediatr. 2016;13:207–14. https://dx.doi.org/10.14238/sp13.3.2011.207-14
10. Hambidge KM, Casey CE, Krebs NF. Zinc. In: Mertz W. Trace elements in human and animal nutrition. 5th Edition. New York: Academic Press, Inc.; 1986. p.1–137.
11. Hambidge KM, Krebs NF. Zinc in the fetus and neonate. In: Polin RA, Abman SH, Rowitch DH, Benitz WE, Fox WW, eds. Fetal Neonatal Physiol. 5th ed. Philadelphia: Elsevier; 2017. p.313–6. ISBN: 978-0-323-35214-7. DOI: https://doi.org/10.1016/B978-0-323-35214-7.00177-3.
12. Patel AL, Engstrom JL, Meier PP, Jegier BJ, Kimura RE. Calculating postnatal growth velocity in very low birth weight (VLBW) premature infants. J Perinatol. 2009 Sep;29(9):618-22. DOI: https://doi.org/10.1038/jp.2009.55
13.Agostoni C, Buonocore G, Carnielli VP, De Curtis M, Darmaun D, Decsi T, et al.; ESPGHAN Committee on Nutrition. Enteral nutrient supply for preterm infants: commentary from the European Society of Paediatric Gastroenterology, Hepatology and Nutrition Committee on Nutrition. J Pediatr Gastroenterol Nutr. 2010;50:85-91. DOI: https://doi.org/10.1097/MPG.0b013e3181adaee0.
14. Ram Kumar TV, Ramji S. Effect of zinc supplementation on growth in very low birth weight infants. J Trop Pediatr. 2012;58:50-4. DOI: https://doi.org/10.1093/tropej/fmr036
15. Jyotsna S, Amit A, Kumar A. Study of serum zinc in low birth weight neonates and its relation with maternal zinc. J Clin Diagn Res. 2015;9:SC01-3. DOI: https://doi.org/ 10.7860/JCDR/2015/10449.5402
16. Díaz-Gómez NM, Doménech E, Barroso F, Castells S, Cortabarria C, Jiménez A. The effect of zinc supplementation on linear growth, body composition, and growth factors in preterm infants. Pediatrics. 2003;111:1002-9. DOI: https://doi.org/10.1542/peds.111.5.1002
17. Friel JK, Andrews WL, Matthew JD, Long DR, Cornel AM, Cox M, et al. Zinc supplementation in very-low-birth-weight infants. J Pediatr Gastroenterol. Nutr. 1993;17:97–104. DOI: https://doi.org/10.1097/00005176-199307000-00015.
18. Islam MN, Chowdhury MA, Siddika M, Qurishi SB, Bhuiyan MK, Hoque MM, et al. Effect of oral zinc supplementation on the growth of preterm infants. Indian Pediatr. 2010;47:845-9. DOI: https://doi.org/
19. Lira PI, Ashworth A, Morris SS. Effect of zinc supplementation on the morbidity, immune function, and growth of low-birth-weight, full-term infants in northeast Brazil. Am J Clin Nutr. 1998;68:418S-24S. DOI: https://doi.org/10.1093/ajcn/68.2.418S. PMID: 9701155. DOI: https://doi.org/ 10.1007/s13312-010-0145-8
20. Ragab SM, Hegran HH, Kassem SA. The effect of zinc supplementation on growth and development in preterm neonates. Menoufia Med J. 2014;27:524-8. DOI: https://doi.org/ 10.4103/1110-2098.145500
21. El Mashad GM, El Sayed HM, Shawky Elghorab AM. Effect of zinc supplementation on growth of preterm infants. Menoufia Med J. 2016;29:1112-5. DOI: https://doi.org/ 10.4103/1110-2098.202496
22. Al-Bahadily AKJM, Al-Omrani AAM, Abdul-Zahraa A. The effect of zinc on the growth of preterm baby in Baghdad, Iraq. Int J Pediatr Res. 2016;3:143-7. DOI: https://doi.org/10.17511/ijpr.2016.i03.02
23. Sonawane R, Patil S, Gulati L, Sonawane S. To study the role of zinc supplementation on growth of low birth weight infants. MVP Journal of Med Sci. 2014;1:25–9. DOI: https://doi.org/10.15306/mvpjms/2014/v1i1/46887.