Zinc supplementation reduces the risk of necrotizing enterocolitis in vert low birth weight neonates: a randomized clinical trial

Objectives & Study: Necrotizing enterocolitis (NEC) remains one of the leading causes of morbidity and mortality in premature neonates1. Modification of immune response and alteration of epithelial barrier play a crucial role in the pathogenesis of NEC. Zinc is an ubiquitous element deeply involved in the development of immune response and essential for epithelial integrity. Preterm neonates are at high risk of zinc deficiency2. In this study we aimed to investigate the efficacy of zinc supplementation in reducing the occurrence of NEC in preterm neonates. Methods: A prospective, double-blind, randomized controlled study was conducted on very low birth weight neonates (birth weight < 1500 g), randomly allocated, at the 7th day of life, in zinc group (receiving 10 mg/d of zinc through a multivitamin product given by oral route) or in placebo group (receiving a similar multivitamin product without zinc). Main endpoint was the rate of neonates presenting NEC. Secondary outcome was mortality rate. Results: We enrolled 97 neonates in the zinc group and 96 in the placebo group. Occurrence of NEC was significantly higher in placebo group (6.3%) compared to the zinc group (0%, p=0.014). Mortality risk was significantly reduced in zinc group (OR 0.275, 95%CI 0.086-0.875, p=0.021). Conclusion: Oral supplementation with high dose of zinc reduces the risk of NEC and mortality in preterm neonates. Additional studies are advocated to investigate the mechanism by which zinc produces observed effects in this particular population