Improved linear growth after routine zinc supplementation in preterm very low birth weight infants

Background: This study was designed (1) to compare growth, morbidity and mortality in < 33-week gestational age (GA) (very preterm, VPT) or very low birth weight (BW < 1500 grams, VLBW) infants before (Epoch-1) and after implementing routine enteral zinc (Zn) supplementation (Epoch-2) to meet recommendations, and (2) to assess serum Zn levels and associated variables. Methods: Single-center prospective cohort of 826 infants. The primary outcome was the change (Delta) in Z-scores of accurate length (Delta length(z)), weight and head circumference from birth to discharge home. Results: In Epoch-2 vs Epoch-1 Delta length(z) adjusted for confounding variables increased by 0.27 [95% confidence interval (CI) 0.13, 0.42, P < 0.001]. However, morbidity and mortality did not change. In Epoch-2 Zn decreased with GA and postnatal age: low ( < 0.74 mcg/mL) levels were observed in 51% infants. Retinopathy of prematurity (ROP) was independently associated with the lowest Zn [adjusted odds ratio 0.042 (CI 0.006, 0.306), area under the curve=0.928]. Conclusion: Routine enteral Zn supplementation was independently associated with improved linear growth but did not prevent occurrence of low Zn. ROP was independently associated with the lowest Zn. Implications: Multicenter studies are needed to assess whether dosage of enteral Zn should be increased and whether Zn could help prevent ROP. Impact: center dot Implementation of routine enteral zinc (Zn) supplementation was associated with improved linear growth from birth to discharge and a more frequent physiologic growth curve in preterm very low birth weight infants. center dot Serum Zn levels decreased with gestational age and with postnatal age. center dot Low serum Zn levels were observed frequently despite routine Zn supplementation as currently recommended, which suggests a need to re-evaluate current enteral zinc supplementation guidelines for this population. center dot Retinopathy of prematurity among infants < 33 weeks' gestation was independently associated with low gestational age, low birthweight, stage of bronchopulmonary dysplasia and the lowest serum Zn level.