الفهرس 
The Low Birth Weight InfantOnly 14 pages are availabe for public view
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Abstract
Low birth weight (LBW) is a challenging public health
problem. Its high priority stems from the fact that it is a major
predictor of infant mortality and that it contributes
substantially to the overall burden of childhood handicap.
Growth and nutritional deficits are almost universal in LBW
babies. Many other sequel of LBW may be attributed to these
growth and nutritional deficits, making them a main target for
early and effective interference. Micronutrient deficiency,
including zinc, contributes greatly to impaired growth, health,
and development of children in less‐developed countries.
Results of studies regarding the role of zinc supplementation
in improving growth in LBW neonates are conflicting. In some
studies, zinc supplementation enhanced more weight gain and
reduced the incidence of low birth weight related problems.
Other studies showed no added benefit of zinc
supplementation to enhance growth or significantly reduce
morbidity in LBW infants.
As zinc status is difficult to identify due to its tight
homeostatic mechanisms, zinc supplementation trials have
become the best source of information about zinc nurture
around the world and especially in risk groups such as
children.
The aim of this randomized placebo‐controlled trial was to
clarify the role of this essential nutrient on growth promotion,
enhancing growth and fasting catch‐up in this vulnerable
group of children, as well as to find out a proposed
Summary and Conclusion
182
relationship between zinc effect on growth and the main
growth hormone mediator, IGF‐1.
This study is a double‐blind randomized placebo‐controlled
trial for assessing the impact of oral zinc therapy on the catchup
growth of low‐birth‐weight neonates delivered at Ain
Shams University Maternity Hospital. A secondary objective
was to measure the levels of serum IGF‐1 in both groups and
to relate those levels to zinc supplementation and catch up
growth in both groups. The study was conducted in Ain Shams
University Maternity Hospital NICU during the period from
October 2010 to May, 2012. The population of this study
comprised 200 LBW neonates of both sexes selected from
those admitted to NICU with a birth weight ranging between
1500 and less than 2500 g. Neonates delivered at less than 28
weeks’ gestation, those with clinical or laboratory evidence of
considerable illness, congenital malformations or
chromosomal aberration syndromes were excluded from the
trial. Eligible neonates were randomly allocated into one of
the following two groups: Group I: LBW neonates, AGA or SGA
on oral zinc therapy at a dose of 20 mg/kg; and Group II: LBW
neonates AGA or SGA on placebo at an equal volume to that of
zinc solution calculated for weight.
Anthropometric measurements were taken including birth
weight and length, head, waist, chest, and mid‐upper arm
circumferences, triceps and sub‐scapular skin fold
thicknesses. Measurements were taken on the right side. In
addition blood samples were taken from all included infants
initially for measurement of serum zinc level, and at 6‐monthold
for measurement of serum IGF‐1 level.
Summary and Conclusion
183
Bottles for oral intake, of the same shape and size were used
to contain either zinc sulfate or placebo. The oral solution
contained 2 grams of zinc sulfate in 100 ml volume with a
concentration of 2 % (20 mg/ml), or the same basic
composition (distilled water) without zinc sulfate (placebo
solution). The bottles were numbered serially by the
independent investigator and the codes were kept
confidential until the study was finished. The dose of therapy
was a volume assumed to supply 20mg/kg/day zinc sulfate
when zinc solution was given. Therapy lasted 6 months of
daily oral intake.
Of the recruited 200 neonates, 121 (60.5%) were males, while
79 (39.5%) were females. The mean gestational age at
delivery was 35.08 ± 1.93 weeks (range: 32 – 40 weeks).
Forty eight (24%) neonates were delivered at term, while 152
(76%) were delivered preterm. The mean birth weight was
1966.29 ± 307.61 g (range: 1500 – 2490 g). Of the included
200 neonates, 129 (64.5%) were appropriate for gestational
age (AGA), while 71 (35.5%) were small for gestational age
(SGA).All of the included 200 neonates were below the 10th
percentile for birth weight; 186 (93%) were below the 10th
percentile for length at birth; while 185 (92.5%) were below
the 10th percentile for HC at birth.The median initial serum
zinc concentration in included neonates was 111.35 g/dl
(range: 31 – 554 g/dl; interquartile range [IQR]: 83.3 – 145.5
g/dl).The recruited neonates were randomized into one of
two groups:Group I [Zinc Group] (n=108): including neonates
who received oral zinc syrup treatment for 6 months; and
Group II [Placebo Group] (n=92): including neonates who
received placebo for the same duration.The overall drop‐out
Summaryrate was 29/200 (14.5%). There was no significant difference
between neonates of both groups regarding initial zinc
concentration. The mean weight at 12‐month‐old follow‐up
visit was significantly higher among infants of group I [Zinc
Group] when compared to those of group II [Placebo Group].
The length, HC, waist circumference, chest circumference,
MAC and triceps SFT were all significantly higher in infants of
group I [Zinc Group] when compared to those of group II
[Placebo Group], and subscapular SFT was still nonsignificantly
different. The proportions of infants, who had
values ≥ the 10th percentile for weight, length and HC at the
12‐month‐old follow‐up visit, were significantly higher in
group I [Zinc Group] when compared to group II [Placebo
Group]. Oral zinc therapy was associated with a 24.88%,
25.98% and 19.6% higher proportion of values ≥ the 10th
percentile regarding weight, length and HC at 12‐month‐old
visit, respectively [NNT = 4, 4 and 5, respectively].The mean
values for weight, length and HC at the 12‐month‐old followup
visit were significantly higher in group I [Zinc Group]
compared to group II [Placebo Group] in infants who were
AGA. The mean values for weight and HC were, however,
comparable in both groups in infants who were SGA.The mean
values for weight, length and HC at the 12‐month‐old followup
visit were significantly higher in group I [Zinc Group] when
compared to group II [Placebo Group] in infants who were
preterm. The mean value for weight was, however,
comparable in both groups in infants who were term.The
mean values for weight, length and HC at the 12‐month‐old
follow‐up visit were significantly higher in group I [Zinc
Group] when compared to group II [Placebo Group] in male
Summary and Conclusion