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

Abstract

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

Similar Occurrence of Febrile Episodes Reported in Non-Atopic Children at Three to Five Years of Age after Prebiotics Supplemented Infant Formula

“…Recent studies showed influence of dietary micronutrient intake on the occurrence of infections. Most of these studies have been done in developing countries [19] in specific patient groups [20], or do not present data about infections [21]. It is difficult to extrapolate these study results to other populations.…”

Malnutrition, Immunodeficiency, and Mucosal Infection

“…A recent study showed that oral supplementation reduced the incidence of necrotizing enterocolitis and overall morbidity and mortality in this population (Terrin et al, 2013). Zinc-fortified formula improved delayed-type hypersensitivity, skin test reactivity, lymphoproliferative response, and increased salivary IgA (Shah and Sachdev, 2006;Schlesinger et al, 1992).…”

“…Attempts to enhance gastrointestinal development and protect against infection and necrotizing enterocolitis have included use of prebiotics and probiotics, which bolster development of the microbiota. A recent study showed that although enteral supplementation with a prebiotic mixture of neutral and Protein calorie malnutrition, dietary deficiency (Moynahan, 1974;Stevens and Lubitz, 1998), high phytate (Moynahan, 1974;Stevens and Lubitz, 1998), transport deficiency (Moynahan, 1974;Stevens and Lubitz, 1998) Supplementation in infection (Stafford et al, 2013) Prenatal maternal supplement (Shah and Sachdev, 2006;Wieringa et al, 2010) Maternal supplementation (Terrin et al, 2013) Infant supplementation (Osendarp et al, 2007;Osendarp et al, 2006) Thymic atrophy, lymphopenia altered T-cell subsets, (Youn et al, 2008;Smith et al, 2008) Humans (Chen, 2012) HIV-1 infection (Shah and Sachdev, 2006;Wieringa et al, 2010;Smith et al, 2008) ↑Microbial diversity, composition, & colonization (Kasaikina et al, 2011) Required for glutathione peroxidase activity ↓NF-κB activity, enhanced virulence of coxsackie B virus Deficiency in HIV-1 linked to progression, antiretroviral therapy increased levels acidic oligosaccharides did increase early postnatal intestinal colonization with a trend toward increased bifidobacteria, extensive use of broad-spectrum antibiotics counteracted the growth of all intestinal microbiota and delayed normal microbiota development (Westerbeek et al, 2013).…”

Enteral Feeding and Infections in Preterm Neonates

“…Thus, premature neonates have relatively high dietary zinc requirements. Recently, it has been demonstrated that dose of zinc higher than those recommended (Table 3) may reduce incidences of NEC, but not of infectious diseases in preterm neonates (Terrin et al 2013). Other studies evaluating the role of zinc in preventing infections in the first months of life are summarized in Table 3.…”

“…Zinc is a structural component of hormones, nucleotides, and proteins (Terrin et al 2013); it is required for the production of a wide variety of enzymes involved in essential metabolic patterns (i.e., protein synthesis, nucleic acid metabolism, immune functions, and organogenesis). Zinc is considered key for optimal functioning of both innate and acquired immunity.…”