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 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 9  |  Issue : 1  |  Page : 77-81

Detection of serum zinc levels in neonates with bronchopulmonary dysplasia


1 Department of Pediatrics, Faculty of Medicine, Tanta University, Tanta, El-Gharbia, Egypt
2 Department of Pharmacology and Toxicology, Faculty of Pharmacy, Tanta University, Tanta, El-Gharbia, Egypt

Date of Submission20-Nov-2019
Date of Decision09-Dec-2019
Date of Acceptance11-Dec-2019
Date of Web Publication29-Jan-2020

Correspondence Address:
Dr. Mohamed Shawky Elfarargy
Assistant Professor of Pediatrics, Faculty of Medicine, Tanta University, Tanta, El-Gharbia
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jcn.JCN_124_19

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  Abstract 


Background: Bronchopulmonary dysplasia (BPD) is common chronic lung disease that occurs mainly in premature neonates who suffered from respiratory distress and managed with oxygen and mechanical ventilation. Aim: The aim of this study is the detection of the serum zinc (Zn) levels in neonates with BPD. Patient and Methods: A prospective case–control study was done on 25 cases of BPD neonates incubated in the neonatal intensive care unit of Tanta University Hospital suffering (patient group) and 25 healthy neonates (who did not develop BPD) with matched gestational age and sex (control group). The study was conducted from August 2016 to February 2018. The sample of venous blood was taken from infants within the first 3 h. Serum Zn levels were determined. Results: Serum Zn levels were significantly lower in neonates who had BPD (patient group) if compared with neonates who did not developed BPD (control group). Cutoff value of the serum Zn levels in cases of BPD was 6.9 μmol/L, the area under the curve was 0.991, the sensitivity was 100%, the specificity was 96%, the positive predictive value was 96%, the negative predictive value was 100%, and the accuracy was 98%. Conclusion: Neonates with BPD are accompanied by decrease in serum Zn levels and it could be used as the early predictor for BPD development in neonates. Recommendation: Zn supplementation to the neonates who are susceptible to develop BPD.

Keywords: Bronchopulmonary dysplasia, neonate, zinc


How to cite this article:
Elfarargy MS, Abu-Risha SE. Detection of serum zinc levels in neonates with bronchopulmonary dysplasia. J Clin Neonatol 2020;9:77-81

How to cite this URL:
Elfarargy MS, Abu-Risha SE. Detection of serum zinc levels in neonates with bronchopulmonary dysplasia. J Clin Neonatol [serial online] 2020 [cited 2020 Feb 23];9:77-81. Available from: http://www.jcnonweb.com/text.asp?2020/9/1/77/277224




  Introduction Top


Bronchopulmonary dysplasia (BPD) is a chronic lung disease (CLD) affecting mainly preterm and especially those who were born <28 weeks of gestation.[1] BPD leads to disrupted lung development and progressive neonatal morbidity, which may persist until infancy and childhood.[1]

BPD is considered a chronic chest disease which is characterized by the signs of respiratory distress (RD), including tachypnea, retraction, grunting, and up to cyanosis with affection of the function of the lung in gas exchange due to damage of the alveoli by replacing the thin alveolar tissues, which are used in gas exchange by fibrous tissues. BPD diagnosis is estimated when there is a requirement for supplemental O2 at 36 weeks postmenstrual age.[1],[2]

The pathogenesis of neonatal BPD is considered multifactorial, and there is no single cause is accused for the development of neonatal BPD. The low gestational age (GA), prolonged exposure to high O2, and prolonged ventilation are considered the main risk factors for the development of neonatal BPD.[2],[3]

Some studies have shown the importance of genetic susceptibility in the development of neonatal BPD, and this may explain the development of BPD in certain neonates, while the other neonates did not develop BPD, although that they had exposed to the same risk factors.[4],[5]

Preterm neonates are mainly presented with decreased in Zinc (Zn) stores and increased liability to Zn deficiency and also, they are liable to develop BPD.[6]

Zn is one of the most important trace elements in neonates, which is considered an essential trace element.[7] Zn is vital for the activity and normal function of a number of proteins and essential for normal healthy tissues, especially those of the respiratory tract.[8]

Zn acts as an important antioxidant trace element and helps in the stabilization of the cell membranes and plays an important role in the regeneration of damaged tissues by antagonizing the catalytic enzymes.[9] Zn is mainly needed for the syntheses of DNA proteins involved in tissue formation and repair.[7],[8],[9]

Zn has an important role in many important functions in the body such as cell division, immune mechanism, and tissue repair, especially those of the lung.[10]

Zn deficiency leads to the affection of the skin, increases the susceptibility to infections, and causes affection of tissue repair following various injuries, especially the respiratory tissues.[11] There is susceptibility to Zn deficiency in neonates, especially preterm neonates as there may be no enough hepatic Zn stores.[12] Preterm has a high Zn requirement for growth and also is susceptible to injuries needing tissue repair with the reduction of duration of pregnancy, which lead to decreased the amount and number of hepatic stores of Zn.[13],[14]

The aim of this study is the detection of serum Zn levels in neonates with BPD.

Recommendation

Zn supplementation of neonates who are susceptible to develop BPD.


  Patient and Methods Top


Study population

A prospective case–control study was done on 25 cases of BPD neonates incubated in the neonatal intensive care unit of Tanta University Hospital (patient group) (we started the study with 70 neonates where three neonates were died, three neonates transferred to another hospital, and 39 neonates were not progress to be diagnosed as BPD and excluded from the study, so the cases who were included in this study results were 25 BPD cases) and 25 healthy neonates (who did not develop BPD) with matched GA and sex (control group). The study was carried out from August 2016 to February 2018.

Mild BPD is a neonatal treatment with >21% O2 for at least 28 days and the ability to keep in room air without RD at 36 weeks GA or discharge (in <32 weeks) and the ability to respire room air without RD at the age of >28 days or at discharge (in ≥32 weeks) (3). Moderate BPD is a neonatal treatment with >21% O2 for at least 28 days and the ability to keep with <30% O2 without RD at 36 weeks GA or discharge (in <32 weeks) or O2 requirement (<30%) at age of >28 days or at discharge (in ≥32 weeks) (3). Severe BPD is a neonatal treatment with >21% O2 for at least 28 days and the need for ≥30% O2 for normal breathing without RD at 36 weeks GA or discharge (in <32 weeks) or O2 requirement (≥30%) at the age of >28 days or at discharge (in ≥32 weeks).[15]

Measuring of serum Zn was done for all neonates in this study within the first 3 h after delivery before any nutrition or therapies were given.

Inclusion criteria

Neonates who had developed BPD whatever its grade were included in the study.

Exclusion criteria

Neonatal sepsis, diseases of the respiratory diseases other than BPD, mothers who had Zn deficiency, and mothers who had Zn supplementation were excluded from the study.

This study was approved by the Ethics Committee of the Faculty of Medicine, Tanta University. Written informed consent was signed from the parents of all neonates.

Data collections

Collecting history, local chest examination, and respiratory examination were done for the diagnosis of BPD. Chest X-ray was done for all studied neonates.

Laboratory workup

1 cc of blood was taken from the studied neonates, within the 1st 3 h after birth and proceeding to any nutrition or therapies, on ethylenediaminetetraacetic acid tubes and had been centrifuged at 3500 rpm for the quarter of an hour.

Serum Zn was taken by preparing a commercially present colorimetric assay kit.[16]

Statistical analysis

The computer program, which had been done for every statistical calculation, was SPSS version 21, IBM, Armonk, NY, USA. Data are expressed as mean ± standard deviation, range. The t-test was done for comparisons between two means; the F-test was done for comparisons between more than two means; and the Chi-square test of significance was used to compare the proportions between qualitative parameters of normally distributed variables. P < 0.05 was considered statistically significant.


  Results Top


[Table 1] showed comparative demographic and clinical data of the studied groups, which revealed nonsignificant differences in GA, weight, and sex between the patient and control group (P > 0.05), whereas there was a significant difference in Apgar score at 5 min and down score between both groups (P = 0.001).
Table 1: Comparative demographic and clinical data of the studied groups (n=25)

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[Table 2] showed a degree of neonates in patient group where there were 15 cases (60%) had mild degree of BPD, 7 cases (28%) had moderate BPD, and 3 cases (12%) had grade severe BPD.
Table 2: Degree of bronchopulmonary dysplasia in the patient group (n=25)

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[Table 3] showed the serum Zn levels of the patient and control group where the mean serum Zn levels in the patient group was 5.26 ± 1.06 μmol/L, whereas the mean levels of serum Zn in the control group was 12.89 ± 2.09 μmol/L, which showed a statistically significant difference between the serum Zn levels in the patient and control group where the serum Zn levels in the BPD neonates (patient group) were significantly lower than the neonates who did not suffered from BPD (control group) (P = 0.001).
Table 3: Comparison between the serum zinc levels between the patient and control group (n=25)

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[Table 4] showed the serum Zn levels in different degrees of BPD in the patient group, which showed that the mean levels of serum Zn in the neonates with mild BPD were 5.8 ± 0.5 μmol/L, the mean serum Zn levels in the neonates with moderate BPD were 4.1 ± 0.4 μmol/L, and the mean levels of serum Zn in the neonates with sever BPD were 3.1 ± 0.3 μmol/L, which revealed statistically significant differences between the serum levels of Zn in different degrees of BPD where the more severity of the BPD the more decrease in the serum Zn levels (P = 0.001).
Table 4: Comparison between the serum retinol levels in different degrees of bronchopulmonary dysplasia in the patient group

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[Table 5] and [Figure 1] (receiver operating characteristics curve) showed that the cutoff value of the serum Zn levels in cases of BPD was 6.9 μmol/L, the area under the curve was 0.991, the sensitivity was 100%, the specificity was 96%, the positive predictive value (PPV) was 96%, the negative predictive value (NPV) was 100%, and the accuracy was 98%.
Table 5: Sensitivity, specificity, cutoff value, positive predictive value, and negative predictive value of serum zinc in bronchopulmonary dysplasia

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Figure 1: Receiver operating characteristic curve of serum zinc in bronchopulmonary dysplasia

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  Discussion Top


BPD is a CLD, which is considered a serious respiratory disease that occurs mainly in premature neonates who exposed to prolonged ventilation and high levels of O2. In spite of the progress in medical and surgical neonatal care had led to decrease in neonatal morbidities and death, especially those due to respiratory problems, the incidence and complications of neonatal BPD have still high in developing countries.[17]

The study had revealed that the serum Zn levels in the BPD neonates (patient group) were significantly lower than the neonates who did not suffered from BPD (control group) (P = 0.001), significant differences between the serum levels of Zn in different degrees of BPD where the more severity of the BPD the more decrease in the serum Zn levels (P = 0.001), and finally, our study showed that the cutoff value of the serum Zn levels in cases of BPD was 6.9 μmol/L, the area under the curve was 0.991, the sensitivity was 100%, the specificity was 96%, the PPV was 96%, the NPV was 100%, and the accuracy was 98%.

In agreement with the results of this study, which revealed a decrease in the levels of serum Zn in BPD cases, there are several researches and studies recommend that Zn supplementation is vital to enhance the growth of the respiratory tract, including the lung tissues and avoid progressive inflammatory damage caused by the invasive ventilation, prolonged elevated O2 levels, and fragile poorly developed lung tissues in preterm neonates with BPD.[18]

The results of this study were agreed with the results of some studies, which demonstrated a decline in the levels of serum Zn in BPD cases; there are some researchers that stated that Zn is essential for the decrease in the oxidative damage caused by the mechanical ventilation and prolonged exposure to high O2 therapy. Zn causes enhancing the epithelial development, helping in the process of the repair of tissue damage, and protecting against respiratory infection and so leads to minimizing the inflammatory reaction in the chest diseases, especially in the cases of neonatal BPD.[19],[20]

In agreement with the results of this study, there were many studies that concluded that the use of higher Zn doses could reduce the incidence of BPD in premature neonates.[21]

The recommendation of this study was agreed with some studies which recommended that Zn supplementation had enhanced the neonatal growth and improved the general conditions of the neonates suffering from BPD.[22]

The conclusion of our research was agreed with the results of the recent study, which had concluded that Zn levels in the preterm were low and the occurrence of neonatal BPD significantly increased and negatively correlated with Zn serum levels in these neonates.[23]


  Conclusion Top


Neonates with BPD are accompanied by decrease in serum Zn levels, and it could be used as the early predictor for BPD development in neonates.

Limitation of the study

The limited number of neonates in the study, so other studies should be done in the same topic using a larger number of neonates to reach an evident conclusion.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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Summersgill H, England H, Lopez-Castejon G, Lawrence CB, Luheshi NM, Pahle J, et al. Zinc depletion regulates the processing and secretion of IL-1β. Cell Death Dis 2014;5:e1040.  Back to cited text no. 11
    
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Grahn BH, Paterson PG, Gottschall-Pass KT, Zhang Z. Zinc and the eye. J Am Coll Nutr 2001;20:106-18.  Back to cited text no. 12
    
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Jobe AH, Bancalari E. Bronchopulmonary dysplasia. Am J Respir Crit Care Med 2001;163:1723-9.  Back to cited text no. 15
    
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Johnsen O, Eliasson R. Evaluation of a commercially available kit for the colorimetric determination of zinc in human seminal plasma. Int J Androl 1987;10:435-40.  Back to cited text no. 16
    
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Zysman-Colman Z, Tremblay GM, Bandeali S, Landry JS. Bronchopulmonary dysplasia-trends over three decades. Paediatr Child Health 2013;18:86-90.  Back to cited text no. 17
    
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Biniwale MA, Ehrenkranz RA. The role of nutrition in the prevention and management of bronchopulmonary dysplasia. Semin Perinatol 2006;30:200-8.  Back to cited text no. 18
    
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Prasad AS. Zinc is an Antioxidant and Anti-Inflammatory Agent: Its Role in Human Health. Front Nutr 2014;1:14.  Back to cited text no. 19
    
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Wu W, Bromberg PA, Samet JM. Zinc ions as effectors of environmental oxidative lung injury. Free Radic Biol Med 2013;65:57-69.  Back to cited text no. 20
    
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Terrin G, Berni Canani R, Passariello A, Messina F, Conti MG, Caoci S, et al. Zinc supplementation reduces morbidity and mortality in very-low-birth-weight preterm neonates: A hospital-based randomized, placebo-controlled trial in an industrialized country. Am J Clin Nutr 2013;98:1468-74.  Back to cited text no. 21
    
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Shaikhkhalil AK, Curtiss J, Puthoff TD, Valentine CJ. Enteral zinc supplementation and growth in extremely-low-birth-weight infants with chronic lung disease. J Pediatr Gastroenterol Nutr 2014;58:183-7.  Back to cited text no. 22
    
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Vázquez-Gomis R, Bosch-Gimenez V, Juste-Ruiz M, Vázquez-Gomis C, Izquierdo-Fos I, Pastor-Rosado J. Zinc concentration in preterm newborns at term age, a prospective observational study. BMJ Paediatr Open 2019;3:e000527.  Back to cited text no. 23
    


    Figures

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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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