Neonatal zinc supplementation for prevention of mortality and morbidity in breastfed low birth weight infants: Systematic review of randomized controlled trials

Gulani, Anjana; Bhatnagar, Shinjini; Sachdev, H. P. S.

doi:10.1007/s13312-011-0043-8

Cited by 15 publications

(10 citation statements)

References 19 publications

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“…The dietary recommendations for preterm neonates suggest 1.1-2 mg $ kg Zn 21 $ d 21 (29). We used higher zinc doses; the use of zinc doses above the dietary guidance level is an emerging research area in pediatric nutrition (10,16). Many studies suggest that 10-20 mg Zn/d is able to limit the risk of infections in children (40)(41)(42).…”

Section: Discussionmentioning

confidence: 99%

“…Total zinc intake in the zinc group ranged from 9.7 to 10.7 mg/d. High doses in preterm neonates seem justified because of the lower stores at birth, the higher requirements for growth, and potentially other stress factors present during prematurity (16). In a large trial, Sazawal et al (15) showed a reduction in mortality in the first 9 mo of life in an RCT that enrolled full-term small-for-gestational-age infants who received oral zinc supplementation at high doses (5 mg/d).…”

Section: Discussionmentioning

confidence: 99%

“…However, studies on zinc homeostasis in neonates have produced somewhat conflicting results regarding zinc requirements and optimal daily intakes (1)(2)(3)14). There is a wealth of evidence that zinc, at different doses, has a positive influence on morbidity, mortality, and growth in infants and children (15)(16)(17). Recent trials have suggested that high doses of zinc as co-treatment against infections early in the life (18,19).…”

Section: Introductionmentioning

confidence: 99%

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Zinc supplementation reduces morbidity and mortality in very-low-birth-weight preterm neonates: a hospital-based randomized, placebo-controlled trial in an industrialized country

Terrin¹,

Canani²,

Passariello³

et al. 2013

The American Journal of Clinical Nutrition

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Background: Zinc plays a pivotal role in the pathogenesis of many diseases and in body growth. Preterm neonates have high zinc requirements. Objective: The objective of the study was to investigate the efficacy of zinc supplementation in reducing morbidity and mortality in preterm neonates and to promote growth. Design: This was a prospective, double-blind, randomized controlled study of very-low-birth-weight preterm neonates randomly allocated on the seventh day of life to receive (zinc group) or not receive (control group) oral zinc supplementation. Total prescribed zinc intake ranged from 9.7 to 10.7 mg/d in the zinc group and from 1.3 to 1.4 mg/d in the placebo control group. The main endpoint was the rate of neonates with $1 of the following morbidities: lateonset sepsis, necrotizing enterocolitis, bronchopulmonary dysplasia, periventricular leucomalacia, and retinopathy of prematurity. Secondary outcomes were mortality and body growth. Results: We enrolled 97 neonates in the zinc group and 96 in the control group. Morbidities were significantly lower in the zinc group (26.8% compared with 41.7%; P = 0.030). The occurrence of necrotizing enterocolitis was significantly higher in the control group (6.3% compared with 0%; P = 0.014). Mortality risk was higher in the placebo control group (RR: 2.37; 95% CI: 1.08, 5.18; P = 0.006). Daily weight gain was similar in the zinc (18.2 6 5.6 g $ kg 21 $ d 21 ) and control (17.0 6 8.7 g $ kg 21 $ d 21

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Zinc supplementation reduces morbidity and mortality in very-low-birth-weight preterm neonates: a hospital-based randomized, placebo-controlled trial in an industrialized country

Terrin¹,

Canani²,

Passariello³

et al. 2013

The American Journal of Clinical Nutrition

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“…Few studies have evaluated the role of zinc in neonatal and early infancy periods in LBW infants. The two large community trials among these infants [19,20], a meta-analysis of whose results [21] does not suggest benefit of zinc supplementation to LBW infants, had enrolled mostly term LBW infants with a mean birth weight of more than 2,000 g. On the other hand, studies in infants with a lower birth weight (<2,000 g) suggest that there is a positive effect of zinc supplementation on growth [22,23,24,25] and motor development of these infants [25]. Also, one large community-based trial on zinc supplementation in children aged 1–35 months in Nepal reports a 44% reduction in mortality among the subgroup of infants less than 2,000 g (RR 0.56; 95% CI 0.3–1.04) [26].…”

Section: Discussionmentioning

confidence: 99%

Poor Zinc Status in Early Infancy among Both Low and Normal Birth Weight Infants and Their Mothers in Delhi

Agarwal

Virmani²,

Jaipal³

et al. 2012

Neonatology

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Background: Low birth weight (LBW) infants are at high risk of zinc deficiency, but there is a paucity of data on their zinc status. Objective: To evaluate zinc status of LBW (BW <2,500 g) and normal birth weight (NBW; BW ≥2,500 g) infants at birth and in early infancy. Methods: A total of 339 infants (LBW, n = 220; NBW, n = 119) were enrolled, and venous blood samples of mother-infant dyad were taken within 48 h of birth. Infants’ levels were repeated between 2 and 10 months of age. Serum zinc levels were estimated using an inductively coupled plasma mass spectrometer. Primary outcome was zinc deficiency, defined as serum zinc <65 µg/dl. Results: Zinc results were available for 182 LBW and 103 NBW infants at birth and for 100 LBW and 66 NBW infants at follow-up with a median postnatal age of 14 and 15.5 weeks, respectively. Median zinc levels were low and comparable at birth as well as at follow-up, with zinc deficiency being present in 51.0% of LBW and 42.4% of NBW infants at birth and in 79.0% of LBW and 66.7% of NBW infants at follow-up. Zinc levels decreased significantly in both groups from birth to follow-up, irrespective of zinc multivitamin supplementation. Zinc levels of infants with BW <2,000 g at follow-up were significantly lower compared to infants with higher BW. Conclusion: Zinc status was poor in many infants at birth irrespective of BW. Zinc status worsened significantly during early infancy, with infants with BW <2,000 g having the lowest zinc levels.

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“…A large and rapidly growing literature has explored the degree to which zinc supplementation can improve population health in general, and child health in particular [6–10]. While some studies have documented negative effects of zinc supplementation on iron absorption [11], the adverse effects of zinc supplementation on concentrations of hemoglobin, serum ferritin, and serum copper appear limited [12–15].…”

Section: Introductionmentioning

confidence: 99%

Evaluating the cost-effectiveness of preventive zinc supplementation

Fink

Heitner

2014

BMC Public Health

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BackgroundEven though the WHO currently recommends zinc for diarrhea management, no consensus has been reached with respect to routine distribution of zinc for preventive reasons. We reviewed the health impact of preventive zinc interventions, and evaluated the relative cost effectiveness of currently feasible interventions.MethodsUsing the latest relative risk estimates reported in the literature, we parameterized a health impact model, and calculated the expected benefits of zinc supplementation in a representative low-income country. We then computed the cost and cost-effectiveness for three delivery mechanisms: the direct distribution of zinc supplements, the distribution of micronutrient biscuits including zinc, and the distribution of zinc through water filtration systems.ResultsCombining all health outcomes and impact estimates, we find that systematic zinc supplementation among children of ages one to five would avert 1.423 DALYs per 100 households and year in least developed countries. The estimated cost per DALY is US$ 606 for pill supplementation, US$ 1211 for micronutrient biscuits, and US$ 879 per DALY saved for water filtration systems.ConclusionsPreventive zinc supplementation to children of ages 1–5 appears to be a highly cost-effective intervention in typical developing country settings. More research will be needed to determine the most effective mechanism to deliver zinc to this target population.

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Neonatal zinc supplementation for prevention of mortality and morbidity in breastfed low birth weight infants: Systematic review of randomized controlled trials

Abstract: In view of no convincing evidence of benefits from the limited data available, currently there is no justification for recommending routine zinc supplementation for breastfed LBW newborns in developing countries.

Cited by 15 publications

References 19 publications

Zinc supplementation reduces morbidity and mortality in very-low-birth-weight preterm neonates: a hospital-based randomized, placebo-controlled trial in an industrialized country

Zinc supplementation reduces morbidity and mortality in very-low-birth-weight preterm neonates: a hospital-based randomized, placebo-controlled trial in an industrialized country

Poor Zinc Status in Early Infancy among Both Low and Normal Birth Weight Infants and Their Mothers in Delhi

Evaluating the cost-effectiveness of preventive zinc supplementation

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