Increased early enteral zinc intake improves weight gain in hospitalised preterm infants

Harris, T. N.; Gardner, Fumiyuki C.; Podany, Abigail B.; Kelleher, Shannon L.; Doheny, Kim K.

doi:10.1111/apa.14828

Cited by 9 publications

(6 citation statements)

References 24 publications

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“…5,9,[25][26][27] They may present several morbidities and increased mortality if their increased Zn needs remain unmet. 5,25,[28][29][30] On the other hand, these recommendations regarding the dose of Zn supplementation for VLBW infants are quite variable between the guidelines of different institutions. Besides, different dosing regimens were used in studies for SGA, term and preterm infants.…”

Section: Discussionmentioning

confidence: 99%

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Zinc Supplementation in Very Low Birth Weight Infants: A Randomized Controlled Trial

Sahin,

Sari,

Bidev

et al. 2023

Am J Perinatol

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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

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Section: Discussionmentioning

confidence: 99%

“…5 9 25 26 27 They may present several morbidities and increased mortality if their increased Zn needs remain unmet. 5 25 28 29 30…”

Section: Discussionmentioning

confidence: 99%

Zinc Supplementation in Very Low Birth Weight Infants: A Randomized Controlled Trial

Sahin,

Sari,

Bidev

et al. 2023

Am J Perinatol

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“…Preterm newborns have lower serum zinc levels than term infants in the first months of life, and in this group, zinc supplementation during hospitalization is associated with reduced mortality, improved weight gain, and linear growth up to two years of age. 14,15,29 Studies that evaluated serum zinc levels and the effects of supplementation in clinical outcomes such as growth 7,18,19 and development 15,18 in preterm infants after hospital discharge show divergent results. [30][31][32] These publications included moderate or late preterm infants with younger age and lower breastfeeding rates than our study.…”

Section: Discussionmentioning

confidence: 99%

“…Few studies have evaluated the zinc-related nutritional status in moderately and extremely preterm infants after hospital discharge. [14][15][16][17][18][19][20] 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.…”

Section: Introductionmentioning

confidence: 99%

Association of serum and erythrocyte zinc levels with breastfeeding and complementary feeding in preterm and term infants

Azevedo-Silva

Vivi²,

Fonseca³

et al. 2022

J Dev Orig Health Dis

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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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“…Human milk composition was also not chemically analysed, limiting the information about actual intake. Additional confounding factors that could have influenced growth include comorbidities [eg, patent ductus arteriosus (9)], micronutrient intake (12,28,29), steroid exposure (30,31), and the extent to which kangaroo mother care (32) was practiced.…”

Section: Discussionmentioning

confidence: 99%

In‐hospital Growth of Very Low Birth Weight Preterm Infants

Kemp

Becker

Wenhold

2021

J. pediatr. gastroenterol. nutr.

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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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Increased early enteral zinc intake improves weight gain in hospitalised preterm infants

Cited by 9 publications

References 24 publications

Zinc Supplementation in Very Low Birth Weight Infants: A Randomized Controlled Trial

Zinc Supplementation in Very Low Birth Weight Infants: A Randomized Controlled Trial

Association of serum and erythrocyte zinc levels with breastfeeding and complementary feeding in preterm and term infants

In‐hospital Growth of Very Low Birth Weight Preterm Infants

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