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Zinc deficiency limiting head growth to discharge in extremely low gestational age infants with insufficient linear growth: a cohort study

Journal of Perinatology volume 40, pages 1694–1704 (2020)Cite this article

Subjects

Abstract

Objective

To assess the relationship of size for age with zinc deficiency in extremely low gestational age (GA) infants (23–28 weeks, ELGANs) who had insufficient linear growth despite optimizing other nutrients and to analyze changes in fronto-occipital circumference (FOC), weight and length with zinc supplementation.

Study design

Retrospective cohort study.

Results

Among 302 ELGANs, a serum zinc concentration was obtained in 52 with insufficient linear growth (17%). Zinc deficiency (serum concentration <0.74 mcg/ml) was diagnosed in 8 of 24 (33%) small for GA (SGA) compared to 35 of 278 (13%) non-SGA infants (P = 0.01). Zinc supplementation for >2 weeks improved FOC growth to discharge or 50 weeks postmenstrual age in infants with Zn deficiency. However, neither linear growth nor weight gain improved with Zn supplementation.

Conclusion

Zinc deficiency was diagnosed in 14% ELGANs in this cohort. Zinc supplementation for >2 weeks improved FOC growth but not linear growth or weight gain.

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Fig. 1: Flow diagram of the zinc cohort.
Fig. 2: Growth and nutrients supplementation in four very preterm infants with linear growth failure.

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Acknowledgements

The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request. Susan Chacko, RN and Maria DeLeon, RN, were research coordinators for part of this study. Lara Pavageau, MD, was instrumental in the initial steps of the QI project [11]. Charles R. Rosenfeld, MD, participated in the design of the quality improvement project that yielded results presented in this manuscript. Chen Du, RD, Elizabeth Brammer, RD, and Theresa Jacob, RD, dietitians at Parkland Hospital, obtained anthropometric measurements for this study and participated in patient recruitment, assessments of growth and laboratory results, and recommendations for nutritional interventions. Elen Petrosyan, RD, dietitian at Parkland Hospital, helped organizing the logistics of patient recruitment, measurements, and research planning. Sandra Gosser, NNP, helped with education of nurse practitioners and coordination of care with the dietitians and the physicians. Timothy Brannon, MD, helped with changes on EPIC, specifically with implementation of parameters to define AGA at birth. Rebecca Thomas, RN and Catherine Vanbeek, RN, NP, helped with changes in EPIC ordering and education of nurses. Some of the patients included in the QI described in the current manuscript were enrolled in a blinded randomized trial: Clinicaltrials.gov NCT02372136. The study sponsors had no role in design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review and approval of the manuscript, and decision to submit the manuscript for publication.

Author contribution

LPB wrote the first draft of the manuscript. He conceptualized and designed the study. He extracted data from medical records, participated in the interpretation of the data, conducted statistical analyses, critically reviewed the revisions, and approved the final manuscript as submitted. RH conceptualized and designed the study. He participated in the interpretation of the data, critically reviewed the revisions, and approved the final manuscript as submitted. LSB conceptualized and designed the study. He conducted statistical analyses, participated in the interpretation of the data, critically reviewed the revisions, and approved the final manuscript as submitted. CSL and AE conceptualized and designed nutritional guidelines for the NICU and discharge, anthropometric data, and data extraction from EPIC. They obtained anthropometric measurements for the QI and participated in assessments of growth and laboratory results and recommendations for nutritional interventions. They participated in the interpretation of the data, critically reviewed the revisions, and approved the final manuscript as submitted. PJB collected and entered data into the databases; she participated in the interpretation of the data, critically reviewed the manuscript, and approved the final manuscript as submitted. MC was research coordinator for a large part of this study. She measured patients in the NICU and at follow-up. She extracted data from medical records into databases, critically reviewed the manuscript, and approved the final manuscript as submitted.

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Authors and Affiliations

  1. Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Luc P. Brion, Roy Heyne, Patti J. Burchfield & Maria Caraig

  2. Parkland Health and Hospital System, Dallas, TX, USA

    L. Steven Brown, Cheryl S. Lair & Audrey Edwards

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Correspondence to Luc P. Brion.

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Brion, L.P., Heyne, R., Steven Brown, L. et al. Zinc deficiency limiting head growth to discharge in extremely low gestational age infants with insufficient linear growth: a cohort study. J Perinatol 40, 1694–1704 (2020). https://doi.org/10.1038/s41372-020-00778-w

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