Effect of Zinc Supplement Provision on Growth and Neurodevelopmental Parameters in Preterm Neonates

Document Type : Original Article

Authors

1 Neonatology Division, Department of Pediatrics, Faculty of Medicine, Universitas Brawijaya, Saiful Anwar Malang General Hospital, Malang, Indonesia

2 Department of Pediatrics, Faculty of Medicine, Universitas Brawijaya, Saiful Anwar Malang General Hospital, Malang, Indonesia

Abstract

Background: Zinc deficiency often occurs in preterm and low-birth-weight neonates. The present study aimed to assess the effect of zinc supplement provision on increased body weight, body length, and head circumference, as well as neurodevelopmental parameters of preterm neonates.
Methods: A true experimental study with a double-blind, randomized clinical trial (RCT) was conducted involving 30 preterm neonates with 30-34 weeks of gestational age who were assigned to two groups, i.e., zinc supplements and placebo, and followed until the three months of corrected age.
Results: The mean score of zinc level in all subjects was 34.47±12.00 µg/dL. There were significant differences in serum zinc level at birth compared to the corrected age of three months, both in the supplement group and placebo (P< 0.001, each). Zinc level showed a significant positive correlation with body weight, length, and head circumference at the corrected age of three months (r=0.469, P=0.009; r = 0.428, P= 0.018; r = 0.549, P=0.002). Zinc levels had a significant, positive correlation with BINS at the age of 3-4 months (r = 0.594; P=0.001), IGF-1 (r = 0.496; P< 0.001), body weight (r=0.469; P=0.009), length (r =0.428; P=0.018), and head circumference (r =0.549; P=0.002) at corrected age of three months.
Conclusion: The provision of zinc supplements could positively affect the growth of preterm neonates in the form of body weight, body length, head circumference, IGF-1, and neurodevelopmental improvements.
 

Keywords


  1. Consensus on nutritional care for premature infants. Jakarta: Ikatan Dokter Anak Indonesia; 2016.
  2. Manish P, Gupta B, Suman B, Poonam P, Pramod S, Manisha G, et al. Role of zinc supplementation in growth and neuro-developmental of premature and small for gestational age (SGA) babies. Natl J Community Med. 2012; 3:736–9.
  3. Soon BT. The global action report on preterm birth. Geneva: World Health Organization; 2012.
  4. Blencowe H, Cousens S, Oestergaard MZ, Chou D, Moller AB, Narwal R, et al. National, regional, and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries: a systematic analysis and implications. Lancet. 2012; 379(9832):2162-72.
  5. Roohani N, Hurrell R, Kelishadi R, Schulin R. Zinc and its importance for human health: An integrative review. J Res Med Sci. 2013; 18:144–57.
  6. Classen HG, Gröber U, Löw D, Schmidt J, Stracke H. Zinc deficiency. Symptoms, causes, diagnosis and therapy. Med Monatsschr Pharm. 2011; 34(3):87–95.
  7. El Sadek AE, El Faiky OA, Behiry EG, El Said WN. The effect of zinc supplementation on growth and development in preterm neonates. Int j Adv Res Pub. 2016; 4:2713–20.
  8. Salgueiro MJ, Zubillaga M, Lysionek A, Sarabia MI, Caro R, De Paoli T, et al. Zinc as an essential micronutrient: A review. Nutrition Research. 2000; 20:737–55.
  9. El-Farghali O, El-Wahed MA, Hassan NE, Imam S, Alian K. Early zinc supplementation and enhanced growth of the low-birth weight neonate. Open Access Maced J Med Sci. 2015; 3(1):63–8.
  10. 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(3):1-4.
  11. Ram Kumar TV, Ramji S. Effect of zinc supplementation on growth in very low birth weight infants. J Trop Pediatr. 2012; 58(1):50–4.
  12. Hamza RT, Hamed AI, Sallam MT. Effect of zinc supplementation on growth hormone-insulin growth factor axis in short Egyptian children with zinc deficiency. Ital J Pediatr. 2012; 38:1-7.
  13. Terrin G, Berni Canani R, Di Chiara M, Pietravalle A, Aleandri V, Conte F, et al. Zinc in early life: a key element in the fetus and preterm neonate. Nutrients. 2015; 7:10427–46.
  14. Thureen PJ. Neonatal nutrition and metabolism. Cambridge University Press; 2012.
  15. Kaban RK, Dharmasetiawani N, Siswanto JE. Prevalence and risk factors for hypozincemia in low birth weight infants at a correction age of near-term or term. Sari Pediatri. 2016; 13:207.
  16. Mahmood T, Saeed T, Hussain S, Zulfiqar R. Zinc levels among preterm infants. J Rawalpindi Med Coll. 2015; 18:65–7.
  17. Dahlan MS. Sample Size in medical health and research. 4th ed. Jakarta: Epidemiologi Indonesia; 2016.
  18. Yeoh PL, Hornetz K, Dahlui M. Antenatal care utilisation and content between low-risk and high-risk pregnant women. PLoS One. 2016; 11(3):e0152167.
  19. Wang H, Hu YF, Hao JH, Chen YH, Su PY, Wang Y, et al. Maternal zinc deficiency during pregnancy elevates the risks of fetal growth restriction: a population-based birth cohort study. Sci Rep. 2015; 5(1):11262.
  20. Ballard O, Morrow AL. Human milk composition: nutrients and bioactive factors. Pediatr Clin. 2013; 60(1):49–74.
  21. Fukada T, Yamasaki S, Nishida K, Murakami M, Hirano T. Zinc homeostasis and signaling in health and diseases: Zinc signaling. J Biol Inorg Chem. 2011; 16:1123–34.
  22. Setiawan CN, Sarosa GI, Setiawati M. Linear growth patterns in small for gestational age and preterm infants after zinc supplementation. Paed Indonesiana. 2015; 55:23.
  23. 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; 111:1002–9.
  24. Vázquez-Gomis R, Bosch-Gimenez V, Juste-Ruiz M, Vázquez-Gomis C, Izquierdo-Fos I, Pastor-Rosado J. Zinc concentration in preterm newborns at term age, a prospective observational study. BMJ Paediatr Open. 2019; 3:e000527.
  25. Plum LM, Rink L, Haase H. The essential toxin: impact of zinc on human health. Int J Environ Res Public Health. 2010; 7(4):1342–65.
  26. de Jong M, Cranendonk A, Twisk JWR, van Weissenbruch MM. IGF-I and relation to growth in infancy and early childhood in very-low-birth-weight infants and term born infants. PLoS One. 2017; 12:e0171650.
  27. Ratnasari W. Role of Zinc against the taste function and changes in body weight (a study in less nutrition toddlers with low levels of Albumin in Bojonegoro. Sain Med. 2012; 4:63–7.