Zinc Deficiency in Neonates


Reviewed by Barbara Cormack (Neonatal / Paediatric Dietitian) & Malcolm Battin.
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Risk Factors Signs Treatment References

Zinc is a cofactor for many enzymes and essential for optimal immune function1. Most zinc is accumulated during the 3rd trimester of pregnancy placing preterm infants at high risk of zinc deficiency. After iron it is the most likely trace element to be deficient. Zinc is predominately (95%) found in muscle, bone, skin, and hair. Only 5% is in the liver and plasma. This leads to significant limitations to the assessment of zinc status based on the measurement of plasma or serum zinc. As zinc deficiency is difficult to diagnose accurately, it is better to err on the side of early zinc supplementation.2

Risk Factors

Signs of Zinc Deficiency5,6

NB: The only definite method of diagnosing Zinc deficiency is to note the clinical and biochemical responses to Zinc supplementation.

Guidelines for the Treatment of Zinc Deficiency5,6

If poor growth and serum zinc is <8 mmol/L Tsang recommends double or triple the RDI (1.2mg/kg/day X 2 or 3)

  1. Prescribe orally - 1 to 2 mg elemental Zinc/kg/day
  2. Ensure an adequate intake of Zinc from feeds; 
  3. Monitor serum Zinc weekly.
  4. Treatment is continued until biochemical indexes are normal and growth has improved 


1 Doherty CP, Weaver LT, Prentice AM: Micronutrient supplementation and infection: a double-edged sword? J Pediatr Gastroenterol Nutr 2002, 34(4):346-352.
2 Rao R, Georgieff M: Microminerals. In: Nutrition of the Preterm Infant. 2 edn. Edited by Tsang R, Uauy R, Koletzko B, Zlotkin S. Cincinati: Digital Educational Publishing; 2005: 277-310.
3 Weismann K, Hoyer H: Serum alkaline phosphatase and serum zinc levels in the diagnosis and exclusion of zinc deficiency in man. The American journal of clinical nutrition 1985, 41(6):1214-1219.
4 Zlotkin SH, Atkinson S, Lockitch G: Trace elements in nutrition for premature infants. Clin Perinatol 1995, 22(1):223-240.
5 National Women’s Health Clinical Guidelines Zinc Deficiency in Neonates http://www.adhb.govt.nz/newborn/Guidelines/Nutrition/Zinc.htm. (accessed on 2/12/2012)
6 Groh-Wargo S: Recommeded Enteral Nutrient Intakes. In: Nutritional Care for High-Risk Newborns. 3 edn. Edited by Groh-Wargo S, Thompson M, Hovasi Cox J, Hartline J. llinois: Precept Press; 2000: 231-263.
7 Tsang RC, Uauy R, Koletzko B, Zlotkin SH: Nutrition of the Preterm Infant: Scientific Basis and Practical Guidelines 2edn. Cincinnati: Digital Education Publishing, Inc.; 2005.