Acrodermatitis in Breast-Fed Premature Infants: Evidence for a Defect of Mammary Zinc Secretion

A 2 1/2‐month old preterm infant had failure to gain weight with high caloric intake, and had generalized persistent dermatitis and mild diarrhea. The patient was being fed zinc‐supplemented cow's‐milk‐based formula (Osterfeed). High caloric intake of 8 weeks' and topical treatment of 11 weeks' duration were futile. A thorough investigation revealed low serum zinc concentration. Administration of zinc sulfate 150 mg/day resulted in brisk weight gain and complete clearing of skin lesions. The infant maintained normal levels of zinc 4 months after zinc therapy was discontinued, while being fed unmodified cow's milk and a diet of corn flour. The probability that zinc‐supplemented formulas do not meet the high zinc requirements of premature infants is raised. The importance of plasma or serum zinc examination in preterm infants with slow growth velocity or failure to gain weight despite adequate caloric intake, with or without skin lesions and diarrhea, is emphasized.

Section: Discussionmentioning

confidence: 99%

“…Zinc deficiency has been reported in premature infants fed breast milk (3,4). and in those with or without short-bowel syndrome receiving long-term parenteral nutrition (5)(6)(7).…”

mentioning

confidence: 99%

Clinical Zinc Deficiency During Zinc‐Supplemented Formula

Naveh,

Mandel,

Berant

1989

“…Although overall growth in infants fed their own mother's milk compares favorably with those fed proprietary milk, bone mineralization appears substantially worse in infants fed human milk than in those fed proprietary milk s (18). In addition, several small preterm infants fed exclusively human milk have had symptomatic micronutrient deficiency (10)(11)(12)(13). Thi s indicates that human milk may not always be adequate to fulfill all needs of the infants delivered prior to 32 weeks gestation.…”

Section: Volumementioning

confidence: 99%

“…their biological mother's milk as the sole so urce of nutrients. Recent reports of se vera l such prematurely born infants who have developed sympt omatic micronutrient deficiency during feedings of exclusively hum an milk (10)(11)(12)(13) indicate the importance of measurement of the micronutrients in milk from mothers who deliver prematurely. In order to provide appropriate recommendations for pos sible supplementation, milk analysis must also be carried out for the mo st likely period of exclu siv e milk feed ing (10)(11)(12)(13).…”

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confidence: 99%

Concentrations and Total Daily Output of Micronutrients in Breast Milk of Mothers Delivering Preterm

Moran,

Vaughan,

Stroop

et al. 1983

SummaryThe number of preterm infants fed their own mother's milk appears to be increasing as a result of information suggesting certain benefits over milk from human milk banks or proprietary formulas. It is also apparent that the nutritional requirements of term and preterm infants differ. Thus, the finding of various deficiencies in small preterm infants indicates that studies which examine the nutrient content of milk from mothers who deliver prematurely are important to aid in suggesting appropriate supplementation. In order to provide appropriate recommendations, nutrient content must be assayed during the period of exclusive milk feedings. Accordingly, the concentrations and total daily output of breast milk zinc and copper, and vitamins A, C, and E, were examined in a group of 13 mothers delivering at or before 32 weeks gestation. Collections of a total 24‐h output were obtained every 7 days for the first 7 weeks after delivery. Concentrations of all micronutrients were similar to those reported previously during the first 5 weeks of lactation. Most striking, however, was the progressive decline in total output as well as concentration of zinc. After the first 2 weeks of lactation, levels of copper and vitamins A, C, and E were not affected by the duration of lactation. There was substantial variation between mothers in daily output of all the micronutrients. The low output of these micronutrients suggests that some attempt should be made at monitoring the mineral and vitamin status of small preterm infants fed exclusively human milk for the first 3 months of life. This is particularly true of zinc, and vitamins A, E, and C, which, because of the wide variation in output between mothers, may not always meet the recommended dietary intakes.

“…Second, they lose access to the ideal route of nutrient transfer, i.e., placental transport. It is not surprising, therefore, that Cu (3)(4)(5)(6)(7) and Zn (8,9) deficiencies, as well as Fe-deficiency anemia (10)(11)(12), have been reported in PT infants. Despite these observations, there is little quantitative information available on the amount of trace elements required to prevent deficiencies in very small premature infants.…”

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confidence: 99%

Trace Mineral Balances in Preterm Infants Fed Their Own Mother's Milk

Mendelson,

Bryan,

Anderson

1983

SummaryBalance studies were conducted on preterm infants (birthweight, 1,500 g or less) fed their own mother's milk or formula (SMA with iron®) to compare the relative adequacy of these sources for copper (Cu), iron (Fe), and zinc (Zn). Urine and stools were collected for 72 h from infants aged 1, 2, or 4 weeks while they were fed milk or formula. Infants fed SMA 24 (but not SMA 20) received Cu, Fe, and Zn intakes within the recommended range. They did not, however, achieve estimated in utero retention rates for Fe, and were in negative Cu balance; they did approach in utero retention rates for Zn. Infants fed their own mother's milk received Cu and Zn, but not Fe, in recommended amounts. They achieved in utero retention rates for Cu at each age studied and approached the estimated in utero retention rates for Zn at 4 weeks, but they retained insufficient Fe throughout. Thus, neither the infant's own mother's milk nor this particular formula provides ideal amounts of all three minerals studied—Cu, Zn, and Fe—during the 1st month of life.