Zinc Supplementation in Preterm Neonates with Late-Onset Sepsis: Is It Beneficial?

Abstract

Objective Neonatal sepsis (NS) is a serious neonatal disease. The aim of this study was to detect the role of zinc (Zn) supplementation in preterm neonates with late-onset sepsis (LOS). Study Design A prospective randomized clinical trial study which was done at Tanta University Hospital from August 2016 to March 2018 on 180 preterm neonates with LOS. The studied neonates were divided into two groups: group 1 (90 neonates), which received Zn and antibiotics, and group 2 (90 neonates), which received antibiotics and placebo. In group 1, the neonates received 1.4 mg elemental Zn/kg/d orally for 10 days. Sepsis score, C-reactive protein (CRP), and procalcitonin (PCT) were done for both groups. Results As regards sepsis score, it showed that before beginning the treatment, there were 85 and 84 neonates who had high probable sepsis (HPS) in intervention and control groups, respectively, and this revealed nonstatistically significant difference (non-SSD) between both groups (p-value is 0.756) and after 10 days of treatment, there were 1 and 4 neonates who had HPS in intervention and control group, respectively, and this revealed SSD between both groups (p-value is 0.045*). As regards CRP and PCT, the results showed that before beginning the treatment, the mean ± standard deviation (SD) of CRP and PCT were 39.4 ± 10.1 mg/L and 5.2 + 1.8 ng/mL, respectively, in intervention group, while it was 39.6 + 9.9 mg/L and 5.1 + 1.9 ng/mL, respectively, in control group and this revealed non-SSD between both groups (p-value is 0.893 and 0.717, respectively) and after 10 days of treatment, the mean ± SD of CRP and PCT were 5.3 ± 1.8 mg/L and 0.39 ± 0.13 ng/mL, respectively, in intervention group and 6.1 + 2 mg/L and 0.61 + 0.22 ng/mL, respectively, in control group and this revealed SSD between both groups (p-value is 0.008* and 0.044*, respectively). Conclusion Zn supplementation in preterm neonates with LOS is beneficial in improving the clinical and laboratory finding. Recommendation Zn supplementation for preterm neonates with LOS. Key Points

Zinc Supplementation and the Prevention and Treatment of Sepsis in Young Infants: A Systematic Review and Meta-Analysis

“…Five studies were conducted in India, 2 in Egypt, and one each in Nepal, Pakistan, Bangladesh, and Italy. The study settings included pediatric inpatient wards [25, 27, 29, 30], neonatal ICUs [18, 19, 24, 26, 28, 32], and the community [31]. The characteristics of included studies are as shown in Table 1.…”

“…The minimum sample size reported was 72 children [30] and the maximum population size was 700 children [25]. Eight [18, 19, 24-27, 29, 32] of the included studies reported the therapeutic effect of zinc supplementation, whereas only 3 studies [28, 30, 31] evaluated the preventive efficacy of the zinc supplement. We report below the preventive and therapeutic effects of zinc supplementation in neonates and young infants, respectively.…”

“…A total of 8 trials [18, 19, 24-27, 29, 32] reported the therapeutic effect of zinc supplementation on proven sepsis in infants up to 4 months of age, all in LMICs. Six studies were conducted in infants admitted to intensive care with sepsis whereas 2 studies recruited infants from inpatient facilities.…”

“…After removal of duplicates and the initial title and abstract screening, 10 studies underwent full-text screening. After full-text screening and inclusion of one article from other resources, 11 RCTs [18,19,[24][25][26][27][28][29][30][31][32] were finally included in the review.…”

Comparison of Mean Weight, Length and Head Circumference in Preterm Neonates with Zinc Supplement Group Versus without Zinc Supplement Group

“…10,11 Zinc in human milk, like phosphorus and calcium, might not have been ideal for extremely preterm newborns and feedings of human-milk should be supplemented with extra zinc for this population, according to evidence. 12,13 Marthur et al (2015) 14 at Maulana Azad Medical College, New Delhi, India, studied the effects of zinc supplementation on the growth of premature newborns. They observed that (those receiving oral zinc supplementation) had significantly greater mean serum alkaline phosphatase levels than the controls at 3 months corrected age.…”