الفهرس 
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Abstract
Evidence for an effect of zinc supplementation on the growth of children came from a recent meta-analysis that concluded that zinc supplementation during childhood is responsible for statistically significant effect on growth. Zinc is a nutrient essential for maintaining 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 therefore cell division. Zinc deficiency has been associated with reduced growth, impaired immunity, and increased prevalence and incidence of infectious diseases among infants and children in developing countries. Preterm and LBW infants in our developing countries are especially vulnerable for zinc deficiency due to: 1. Inadequate prenatal maternal intake of zinc and other micronutrients. 2. Most of fetal zinc is acquired during last trimester. 3. High growth rate of preterm infants and increased demand for zinc despite inadequate stores. 4. Fluctuation of zinc postnatally in breast milk, pointing to inadequacy of breast milk as the sole source of zinc, this is supported by studies demonstrating cases with zinc deficiency found among exclusively breast feed preterm babies.The current study was done to evaluate the effect of zinc supplementation on growth and development in preterm neonates in the first six months of life. The present study was carried out on 80 healthy preterm infants between 32-36 weeks divided into 2 groups. • Group I (zinc supplemented group): Included 40 preterm infants fed with breast milk, and supplemented with multivitamins and zinc (2 mg / kg / day). • Group II (non zinc supplemented group): included 40 preterm neonates fed breast milk with multivitamins only (without zinc supplementation). They were matched with the supplemented group as regards gestational age, birth weight, sex, and modes of delivery. All children underwent thorough history taking, physical examination laying stress on anthropometry (weight, length & head circumference), and laboratory investigations including Hb, alkaline phosphatase and serum zinc level. Also, developmental screening using Age and Stage Questionnaire was done at 4 and 6 months of their corrected ages. In present study, with comparison between both groups regarding anthropometry, it was found that: 1- Zn supplemented group had significant increase (P <0.001) in both weight and length at 3 and 6 months compared to other control (non supplemented group); reflecting significant effect of zinc supplementation on growth of preterm infant. 97 2- On the other hand, there was no significant increase (P>0.05) of head circumference of zinc supplemented group at the same time of 3 and 6 months of follow up. In present study we have compared both groups concerning ALP, Hb and serum zinc level to find that: 1- Serum alkaline phosphatase in zinc supplemented group has risen significantly when measured at 3 and 6 months of corrected age, denoting posititive effect of zinc supplementation on bone growth. 2- Also as regards hemoglobin, it was found to increase significantly (P <0.001) at 3 and 6 months of corrected age, in zinc supplemented group, offering premature infants some protection against anemia, to whom, they are exposed and convenient to rapid growth rate they need. 3- Serum zinc levels measured, were significantly higher (P <0.001) in zinc supplemented group at 3 and 6 months of corrected age, denoting improvement of their zinc status after supplementation, for proper comparison with non zinc supplemented group. As regards developmental milestones, comparison between both groups made by application of Age & Stage Questionnaire, in the following items: 1- Gross motor development. 2- Fine motor development. 3- Communication skills. 4- Problem solving. 5- Personal social development. This involved detailed questions to the parents for previous aspects of development at 4 and 6 months of age of their infants after correction 98 as postnatal age should be corrected for prematurity before application (i.e. corrected age = postnatal age in weeks – [40 weeks – gestational age]). In our study, we noted that the developmental score of zinc supplemented group was significantly higher (p<0.001) than non supplemented group in all tested domains, and this positive effect of zinc on development may be due to its essential rule in growth and maturation of the nervous system as previously known that: 1-Zinc-dependent enzymes are involved in brain growth. 2-Zinc-finger proteins participate in brain structure and neurotransmission. 3- Zinc -dependent neurotransmitters are involved in brain memory function. 4-Zinc is involved in the precursor production of neurotransmitters. 5-Metallothionein-III is one protein that binds zinc in neurons. In conclusion, zinc supplementation in early infancy was found to be an effective enhancer for both growth and development of preterm infants. So, we recommend zinc supplementation for preterm infants for better growth and development, and recommend further studies of zinc supplementation to be carried out on infants with different durations and at different ages.