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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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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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Hossain Z, Qasem WA, Friel JK, Omri A. Effects of Total Enteral Nutrition on Early Growth, Immunity, and Neuronal Development of Preterm Infants. Nutrients 2021; 13:2755. [PMID: 34444915 PMCID: PMC8401306 DOI: 10.3390/nu13082755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 07/23/2021] [Accepted: 07/25/2021] [Indexed: 11/16/2022] Open
Abstract
The feeding of colostrum and mother's transitional milk improves immune protection and neurodevelopmental outcomes. It also helps with gut maturation and decreases the risks of infection. The supply of nutrients from human milk (HM) is not adequate for preterm infants, even though preterm mother's milk contains higher concentrations of protein, sodium, zinc, and calcium than mature HM. The human milk fortifiers, particularly those with protein, calcium, and phosphate, should be used to supplement HM to meet the necessities of preterm infants. The management of fluid and electrolytes is a challenging aspect of neonatal care of preterm infants. Trace minerals such as iron, zinc, copper, iodine, manganese, molybdenum, selenium, chromium, and fluoride are considered essential for preterm infants. Vitamins such as A, D, E, and K play an important role in the prevention of morbidities, such as bronchopulmonary dysplasia, retinopathy of prematurity, and intraventricular hemorrhage. Therefore, supplementation of HM with required nutrients is recommended for all preterm infants.
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Affiliation(s)
- Zakir Hossain
- Department of Fisheries Biology and Genetics, Bangladesh Agricultural University, Mymensingh 2202, Bangladesh
| | - Wafaa A Qasem
- Department of Surgery, Mubarak AlKabeer Hospital, Hawally 32052, Kuwait;
- Community Medicine Department, Faculty of Medicine, Kuwait University, Kuwait City 13003, Kuwait
| | - James K. Friel
- Richardson Centre for Functional Foods and Nutraceuticals, Department of Human Nutritional Sciences, University of Manitoba, Winnipeg, MB R3T 6C5, Canada;
| | - Abdelwahab Omri
- The Novel Drug and Vaccine Delivery Systems Facility, Department of Chemistry and Biochemistry, Laurentian University, Sudbury, ON P3E 2C6, Canada;
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Abstract
Cynk jest jednym z głównych pierwiastków śladowych organizmu, spełniającym rolę katalityczną, strukturalną i regulacyjną. Jest niezbędny do podziałów komórkowych i różnicowania powstających komórek, uczestniczy w homeostazie, reakcjach odpornościowych, w apoptozie i starzeniu się organizmu. Cynk jest również składnikiem wielu enzymów i białek oraz odgrywa ważną rolę w spermatogenezie i syntezie hormonów steroidowych. Niedostateczna podaż cynku dotyczy ok. 30% ludności świata. Oprócz niedostatecznej podaży z pokarmem, przyczyną niedoboru cynku mogą być niektóre schorzenia oraz nieprawidłowe wchłanianie tego pierwiastka. Schorzenia, wynikające z niedoboru tego pierwiastka, mogą występować zarówno u dzieci, jak i dorosłych. Suplementacja diety preparatami cynku w wielu przypadkach jest niezbędna, jednak samodzielne jego stosowanie, bez stwierdzonego niedoboru i bez konsultacji z lekarzem, może doprowadzić do występowania działań niepożądanych w wyniku jego nadużywania, w tym także niebezpiecznych interakcji z innymi stosowanymi preparatami i żywnością.
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Ackland ML, Michalczyk AA. Zinc and infant nutrition. Arch Biochem Biophys 2016; 611:51-57. [PMID: 27317042 DOI: 10.1016/j.abb.2016.06.011] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 05/23/2016] [Accepted: 06/13/2016] [Indexed: 01/12/2023]
Abstract
Zinc is essential for a wide variety of cellular processes in all cells. It is a critical dietary nutrient, particularly in the early stages of life. In the early neonatal period, adequate sources of zinc can be obtained from breast milk. In rare circumstances, the mammary gland produces zinc deficient milk that is potentially lethal for exclusively breast-fed infants. This can be overcome by zinc supplementation to the infant. Alterations to key zinc transporters provide insights into the mechanisms of cellular zinc homeostasis. The bioavailability of zinc in food depends on the presence of constituents that may complex zinc. In many countries, zinc deficiency is a major health issue due to poor nourishment. Young children are particularly affected. Zinc deficiency can impair immune function and contributes to the global burden of infectious diseases including diarrhoea, pneumonia and malaria. Furthermore, zinc deficiency may extend its influence across generations by inducing epigenetic effects that alter the expression of genes. This review discusses the significance of adequate zinc nutrition in infants, factors that influence zinc nutrition, the consequences of zinc deficiency, including its contribution to the global burden of disease, and addresses some of the knowledge gaps in zinc biology.
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Affiliation(s)
- M Leigh Ackland
- Centre for Cellular and Molecular Biology, School of Life and Environmental Sciences, Deakin University, Burwood, Victoria 3125, Australia.
| | - Agnes A Michalczyk
- Centre for Cellular and Molecular Biology, School of Life and Environmental Sciences, Deakin University, Burwood, Victoria 3125, Australia
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Finch CW. Review of trace mineral requirements for preterm infants: what are the current recommendations for clinical practice? Nutr Clin Pract 2014; 30:44-58. [PMID: 25527182 DOI: 10.1177/0884533614563353] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Inadequate nutrient stores at birth are an inevitable consequence of being born prematurely. Preterm infants also have high nutrient requirements, which increase with earlier gestational ages. As a result, early nutrition intervention is required to prevent further deficits that, if not corrected, can affect growth and long-term outcomes. Preterm infants often require several weeks of parenteral nutrition (PN) support, which includes trace mineral supplementation. Trace minerals are considered essential nutrients, unable to be synthesized in the human body. Deficiencies of trace minerals have been reported, yet evidence-based guidelines for assessment and supplementation have not been clearly defined. Food and Drug Administration-approved parenteral trace mineral intake guidelines are more than 30 years old. In an effort to more clearly define trace mineral supplementation and monitoring guidelines for preterm infants, a review of literature was performed with the purpose to (1) summarize trace mineral roles in preterm infants, (2) describe clinical signs of deficiency and toxicity, and (3) present intake recommendations and considerations for preterm infants based on current available literature. Review of literature was completed using PubMed and Cochrane databases to find relevant studies specific to trace mineral requirements for preterm infants, trace mineral supplementation of PN, human milk fortifiers, and preterm infant formulas. Review of literature supports that trace mineral depletion can lead to clinical compromise in preterm infants; therefore, suggesting that every effort be made to ensure adequate provision of trace minerals is given to preterm infants. Practical considerations for the clinical nutrition management of preterm infants were also identified in this review.
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