284 - Zinc Supplementation in Preterm Neonates at Risk for Bronchopulmonary Dysplasia: A Randomized Trial

Monday, May 1, 2023

9:30 AM – 11:30 AM ET

Poster Number: 284
Publication Number: 284.428

Ariel Tarrell, University of Utah School of Medicine, Salt Lake City, UT, United States; Mehtab K. Sekhon, Royal Columbian Hospital, Surrey, BC, Canada; Sabrina Malone Jenkins, University of Utah, Salt Lake City, UT, United States; Bradley A. Yoder, University of Utah School of Medicine, Salt Lake City, UT, United States

Presenting Author(s)

AT

Ariel Tarrell, MD

NICU Fellow
University of Utah School of Medicine
Salt Lake City, Utah, United States

Background: Multiple factors contribute to growth failure in premature infants with bronchopulmonary dysplasia (BPD). Poor nutritional status may impact infants with BPD by delaying repair of damaged lung and growth of new lung tissue. Zinc, an important micronutrient, has been suggested to improve growth of infants with BPD. It is not known if zinc plays a role in progression of BPD.

Objective: The objective is to determine if additional enteral zinc supplementation significantly improves growth compared to standard of care in preterm infants at high risk for BPD.

Design/Methods: This is a prospective randomized trial of preterm infants born at 23 – 29 weeks and ≤ 1000 grams with a combined 14-day BPD probability score for moderate-severe BPD or death ≥ 50% (2011 NICHD BPD Outcome Estimator). Infants were randomized to receive additional enteral zinc (2 mg/kg/day) or standard nutrition to 36 weeks corrected gestational age (CGA). Growth was assessed by serial weight, length, and head circumference measurements and serial speed of sound (SOS) quantitative tibial bone ultrasound (Sunlight Omnisense 8000) until 36 weeks CGA. BPD severity was assessed at 36 weeks CGA using the 2019 Neonatal Research Network definition. Enrollment was discontinued early due to low enrollment and interim analysis indicating no difference in growth between groups.

Results: We enrolled 35 infants with mean gestation 25.8 weeks (SD + 1.3) and birth weight 733 grams (+ 141). Of these, 19 (54%) randomized to the zinc group and 16 (46%) to the control group. There were no differences in baseline characteristics of sex, gestational age, birth weight, tibial bone SOS, nor in the 14-day BPD probability score between groups. For growth, there were no differences in weight, length, or head circumference at 36 weeks CGA between groups. There was no difference in tibial bone SOS at 36 weeks CGA between groups. In the control group, more infants had stage 1 BPD (12/16, 75%) than stage 2 BPD (4/16, 25%). Conversely, more infants in the zinc group had stage 2 BPD (13/19, 68%) than stage 1 BPD (6/19, 32%). Stage 2 BPD was significantly higher in the zinc group compared to the control group (p < 0.05).

Conclusion(s):

An additional 2 mg/kg/d of supplemental enteral zinc did not improve growth of preterm infants at high risk for BPD. Severity of BPD was not improved by supplemental zinc. More research is needed to determine if there is optimal zinc supplementation strategy in infants at risk for BPD.