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ORIGINAL ARTICLE
Year : 2016  |  Volume : 29  |  Issue : 4  |  Page : 1112-1115

Effect of zinc supplementation on growth of preterm infants


1 Department of Paediatrics, Faculty of Medicine, Menoufiya University, Menoufiya, Egypt
2 Department of Paediatrics, General Hospital, Menoufiya, Egypt

Date of Submission24-Mar-2016
Date of Acceptance22-May-2016
Date of Web Publication21-Mar-2017

Correspondence Address:
Amr M Shawky Elghorab
Shebin El-kom-Batanoun, Menoufia, 32721
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1110-2098.202496

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  Abstract 

Objective
This work aimed to study the effect of zinc supplementation on growth of preterm infants.
Background
Preterm infants have impaired zinc status because of low body stores, as 60% of fetal zinc is acquired during the third trimester of pregnancy. In addition, this can be attributed to their limited capacity to absorb and retain micronutrients, coupled with increased endogenous losses associated with organ immaturity.
Patients and methods
The present study was carried out on 60 healthy preterm infants below 37 weeks of age divided into two groups: a zinc-supplemented group fed with breast milk and supplemented with zinc (2 mg/kg/day) since the first day of life, and a non-zinc-supplemented group fed with breast milk (without zinc supplementation). Both groups were followed up for 6 months for growth and serum levels of zinc and hemoglobin at the age of 6 months.
Results
The zinc-supplemented group showed a significant increase (P<0.05) in both weight and length at the age of 6 months. There was a highly significant increase in the serum zinc and hemoglobin levels in the zinc-supplemented group compared with the non-zinc-supplemented group, in addition to a significant positive correlation between zinc level and hemoglobin level at day 1 and at 6 months.
Conclusion
Zinc supplementation for preterm low birth weight babies was found effective in enhancing the growth in early months of life and has a positive effect on their linear growth.

Keywords: 6 months, growth, hemoglobin, preterm, zinc


How to cite this article:
El Mashad GM, El Sayed HM, Shawky Elghorab AM. Effect of zinc supplementation on growth of preterm infants. Menoufia Med J 2016;29:1112-5

How to cite this URL:
El Mashad GM, El Sayed HM, Shawky Elghorab AM. Effect of zinc supplementation on growth of preterm infants. Menoufia Med J [serial online] 2016 [cited 2020 Feb 26];29:1112-5. Available from: http://www.mmj.eg.net/text.asp?2016/29/4/1112/202496


  Introduction Top


Preterm birth is often associated with nutritional compromise and impaired growth performance. It is believed that the relation between nutrition and growth is mediated by changes in the hormone and growth factor axis [1].

Zinc deficiency during infancy has a negative effect on the endocrine system, leading to growth failure among other clinical manifestations. Zinc is a key component of cell architecture and function in the organism. It is required for the production of over 200 enzymes, including phosphatases, metalloproteinases, oxidoreductases, and transferases, which are involved in protein synthesis, nucleic acid metabolism, and immune functions. In addition, it is a structural component of various proteins, hormones, and nucleotides [2].

Zinc also plays an important role in gene transcription. Zinc is one of the most prevalent trace elements in the brain. Accordingly, there is evidence that zinc may be essential for brain function as well as for growth of the fetus and child [3].

Preterm infants have a high risk for zinc, copper, and other micronutrient deficiencies and are frequently growth-retarded. There are multiple contributing factors that explain this. As a consequence of shorter gestation and the immaturity of the gastrointestinal tract, these infants have lower body stores. Premature infants also have a high nutrient demand because of rapid postnatal growth and an increased risk for intercurrent diseases, which means that the intake of nutrients may be inadequate during the first months of life [4].

In an attempt to improve the growth of premature infants, various controlled nutritional intervention studies have been conducted. These studies have shown that zinc supplementation has a positive influence on linear growth, motor development [5], and weight gain, and a lower prevalence of diarrhea [6].

Preterm infants are at an increased risk for death; acute and long-term morbidities are often associated with nutritional compromise and impaired growth. With about 13 million preterm babies born each year worldwide, the burden is disproportionately concentrated in Africa and Asia, where about 85% of all preterm births occur (31 and 54%, respectively) [7].


  Patients and Methods Top


This study was carried out on 60 preterm infants (male and female with weight between 1800 and 2500 g) admitted in the NICU at Tala Hospital, Menoufia Governate. The infants were divided into two groups. Group I included preterm infants who received zinc supplementation at a dose of 2 mg/kg/day orally for 6 months. Group II (the control group) included preterm infants who did not receive zinc supplementation.

Consent

Written consent was obtained from their parents before enrollment in the study.

Privacy

All participants' names were hidden and replaced with code numbers to maintain privacy of the participants.

Both groups fulfilled the same inclusion and exclusion criteria.

The inclusion criteria were as follows: Gestational age (GA) between 32 and 36 weeks, birth weight between 1800 and 2500 g, appropriate for GA (birth weight between the 10th and the 90th percentile for GA), and in a stable clinical condition without any evidence of disease likely to influence growth.

The exclusion criteria were as follows: term neonates (>37 weeks of gestation), intrauterine growth restriction, congenital malformations, chromosomal abnormalities, suspected inborn errors of metabolism, multiple gestations, congenital heart disease, and perinatal asphyxia (Apgar <3, longer than 5 min).

All candidates were subjected to a thorough clinical examination, immediately after birth, and anthropometric measurements (weight, length, and head circumference) were recorded. Blood samples were drawn for serum hemoglobin (Hb%) and zinc level determination on the first day. At the age of 6 months, anthropometric measurements (weight, length, and head circumference) for all infants were recorded again. Blood samples were drawn for serum zinc level and Hb% level determination at the age of 6 months.

Approval

Oral informed consent was obtained from the parents of the preterm infants studied. The ethics committee of Faculty of Medicine, Menoufia University, approved the study.

Data management and statistical analysis

This phase included the following: coding of collected data and data entry into the computer, and statistical analysis of the collected data. The collected data were entered into the computer using the Statistical Package for Social Sciences (SPSS; SPSS Inc., Chicago, Illinois, USA) program for statistical analysis. Two types of statistical analyses were carried out: descriptive statistics [e.g. n (%), mean and SD] and analytical statistics (e.g. Student's t-test, Mann–Whitney test, χ2-test, paired t-test, and Pearson's correlation coefficient). A P value of less than 0.05 was considered statistically significant.


  Results Top


The 60 healthy exclusively breastfed preterm infants were divided equally into two groups: the zinc supplemented group and the non-zinc-supplemented group.

In the present study, on comparison between the two groups for anthropometry, it was observed that there was a significant increase in weight and length at 6 months in the zinc-supplemented group compared with the non-zinc-supplemented group.

Our study also found a highly significant increase in the serum zinc levels of the zinc-supplemented group compared with the non-zinc-supplemented group at the age of 6 months, in addition to a significant positive correlation between zinc level and Hb% at day 1 and at 6 months. In the present study, on comparing the two groups in terms of Hb% and serum zinc levels, it was found that the supplemented group acquired significantly higher levels compared with the other group at the age of 6 months.


  Discussion Top


Zinc is a nutrient essential for maintaining the structure and functions of several enzymes, including those that are involved in the production of growth hormones and in transcribing and translating deoxyribonucleic acid and thereby cell division [4].

In the present study, there were statistically significant differences between the two groups as regards weight and length at the age of 6 months. This demonstrates the high bioavailability of oral zinc on raising the serum zinc levels, with subsequent positive effect on weight and length.

In agreement with our study, Islam and colleagues (2010) have found that zinc supplementation for preterm low birth weight babies is effective in enhancing the growth in early months of life. Weight, length, and head circumference were comparable in both groups at enrollment. Significant differences in weight gain and increment in length were found during the first and the second follow-up between the two groups. Reduction in morbidity was apparent in the zinc-supplemented group. No serious adverse effect was noted related to supplementation therapy [8].

Moreover, Díaz-Gómez et al. [9] found in their study on the effect of zinc supplementation on linear growth, body composition, and growth factors in preterm infants that zinc supplementation has a positive effect on linear growth in premature infants.

Moreover, O El-Farghali 2015 [10] conducted a study on early zinc supplementation and enhanced growth of the low-birth-weight neonate. They concluded that early start of oral zinc supplementation in low-birth-weight neonates assists catch-up growth, probably through the rise in insulin-like growth factor-1 [10].

Aminul et al. (2009) in their large study on 200 preterm neonates (between 1200 and 2300 g) divided the cases into two groups: group I, which received 5 mg Zn, and group II, which received placebo. After following up of their weight for 1 month, they found that the weight of infants in the zinc-supplemented group was significantly higher than that in the placebo group (P < 0.001), demonstrating that zinc supplementation in preterm babies enhanced more weight gain and that such babies experienced fewer problems such as infection, convulsion, and jaundice. There was no adverse effect in the zinc-supplemented group [11].

However, there are other contradictory studies such as that of Gulani et al. [12], who viewed that there is no convincing evidence recommending routine zinc supplementation for preterm newborns in developing countries, andMazariegos et al. [13], who in their study on their study on growth of preterm infants showed that no effect on linear growth was observed with dietary phytate reduction, zinc supplementation, or their combination. This contradiction could be explained as the lack of growth response and may be attributed to other micronutrient deficiencies that coexist in this population, limiting the response to zinc. Moreover, this may be due to the difference in the number of studied cases.

In our study, we found a highly significant increase in serum zinc levels in the zinc-supplemented group compared with the non-zinc-supplemented group at the age of 6 months. Moreover, we found a significant positive correlation between zinc level and both weight and length.

In agreement with our study, Islam et al. [8] found that, after supplementation, serum zinc was significantly higher in group I (the zinc-supplemented group) than in group II (the non-zinc-supplemented group).

In our study, we noted a highly significant increase in Hb% levels in the zinc-supplemented group (P < 0.001) at the age of 6 months compared with the non-zinc-supplemented group at the age of 6 months.

This is in agreement with the findings of, Díaz-Gómez et al. [9], O El-Farghali 2015 [10], and Osendarp et al. [14] ([Table 1] and 2).
Table 1 Comparison between the studied groups as regards Apgar, gestational age, HC, length, and weight

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  Conclusion Top


Zinc supplementation for preterm low birth weight babies is found effective in enhancing the growth in early months of life and has a positive effect on their linear growth. Zinc supplementation had a beneficial effect on increasing serum zinc and hemoglobin level of preterm infants.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Berger J, Ninh NX, Khan NC, Nhien NV, Lien DK, Trung NQ, Khoi HH. Efficacy of combined iron and zinc supplementation on micronutrient status and growth in Vietnamese infants. Eur J Clin Nutr 2006; 60:443–454.  Back to cited text no. 1
    
2.
Fahmida U, Rumawas JS, Utomo B, Patmonodewo S, Schultink W. Zinc-iron, but not zinc-alone supplementation, increased linear growth of stunted infants with low haemoglobin. Asia Pac J Clin Nutr 2007; 16:301–309.  Back to cited text no. 2
    
3.
Dijkhuizen MA, Winichagoon P, Wieringa FT, Wasantwisut E, Utomo B, Ninh NX, et al. Zinc supplementation improved length growth only in anemic infants in a multi-country trial of iron and zinc supplementation in South-East Asia. J Nutr 2008; 138:1969–1975.  Back to cited text no. 3
    
4.
Brown KH, López de Romaña D, Arsenault JE, Peerson JM, Penny ME. Comparison of the effects of zinc delivered in a fortified food or a liquid supplement on the growth, morbidity, and plasma zinc concentrations of young Peruvian children. Am J Clin Nutr 2007; 85:538–547.  Back to cited text no. 4
    
5.
Wessells KR, Brown KH. Estimating the global prevalence of zinc deficiency: results based on zinc availability in national food supplies and the prevalence of stunting. PLoS One 2012; 7:e50568.  Back to cited text no. 5
    
6.
Imdad A, Bhutta ZA. Effect of preventive zinc supplementation on linear growth in children under 5 years of age in developing countries: a meta-analysis of studies for input to the lives saved tool. BMC Public Health 2011; 11: (Suppl 3):S22.  Back to cited text no. 6
    
7.
Beck S, Wojdyla D, Say L, Betran AP, Merialdi M, Requejo JH, et al. The worldwide incidence of preterm birth: a systematic review of maternal mortality and morbidity. Bull World Health Organ 2010; 88:31–38.  Back to cited text no. 7
    
8.
Islam MN, Chowdhury MA, Siddika M, Qurishi SB, Bhuiyan MK, Hoque MM, Akhter S. Effect of oral zinc supplementation on the growth of preterm infants. Indian Pediatr 2010; 47:845–849.  Back to cited text no. 8
    
9.
Díaz-Gómez NM, Doménech E, Barroso F, Castells S, Cortabarria C, Jiménez A. The effect of zinc supplementation on linear growth, body composition, and growth factors in preterm infants. Pediatrics 2003; 111(Pt 1):1002–1009.  Back to cited text no. 9
    
10.
O El-Farghali, M Abd El-Wahed, NE Hassan, S Imam, K Alian. Early zinc supplementation and enhanced growth of the low-birth weight neonate. Maced J Med Sci 2015; 3:63–68.  Back to cited text no. 10
    
11.
A Hoque, Shah MD, Keramat A. Role of zinc in low birth weight neonates. Bangladesh Med J 2009; 38:24–30.  Back to cited text no. 11
    
12.
Gulani A, Bhatnagar S, Sachdev HP. Neonatal zinc supplementation for prevention of mortality and morbidity in breastfed low birth weight infants: systematic review of randomized controlled trials. Indian Pediatr 2011; 48:111–117.  Back to cited text no. 12
    
13.
Mazariegos M, Hambidge KM, Westcott JE, Solomons NW, Raboy V, Das A, et al. Neither a zinc supplement nor phytate-reduced maize nor their combination enhance growth of 6- to 12-month-old Guatemalan infants. J Nutr 2010; 140:1041–1048.  Back to cited text no. 13
    
14.
Osendarp SJ, Santosham M, Black RE, Wahed MA, van Raaij JM, Fuchs GJ. Effect of zinc supplementation between 1 and 6 mo of life on growth and morbidity of Bangladeshi infants in urban slums. Am J Clin Nutr 2002; 76:1401-1408.  Back to cited text no. 14
    



 
 
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