Symptomatic zinc deficiency in a breast-fed, premature infant

Hypozincemia and clinical features of acrodermatitis enteropathica developed in a breast-fed, premature infant at 6 months of age. Maternal breast milk zinc levels were normal at birth and at the time of appearance of zinc deficiency in the infant. Zinc supplementation administered orally resulted in rapid improvement. Seven premature infants with hypozincemia and transient symptomatic zinc deficiency have been previously described. In contrast with this case, the other infants received feedings with low zinc content.     

Symptomatic Acquired Zinc Deficiency in At‐Risk Premature Infants: High Dose Preventive Supplementation Is Necessary

Abstract: Zinc is a cofactor for several enzymes involved in many metabolisms. Zinc deficiency induces various disorders such as acrodermatitis enteropathica, either inherited or acquired. We report three cases of premature infants (24–31 wks gestational age) with low birthweight (650 to 940 g) and enteropathy, two of whom presented with necrotizing enterocolitis. All infants were fed by total parenteral nutrition. At a chronological age ranging from 73 to 80 days, all infants developed a periorificial dermatitis. Before the onset of the first signs, they had received zinc supplementation ranging from 146% to 195% of the recommended dose (400 μg/kg/day). Increased zinc supplementation over a course of 6–18 days induced a complete resolution of symptoms in all cases. No abnormality in the neurologic examination and no recurrence were observed at the end of the zinc treatment. Low birthweight premature infants with enteropathy on total parenteral nutrition are at risk of developing zinc deficiency. The usual recommended zinc supplementation is probably insufficient for those infants. A delay in the diagnosis of zinc deficiency may lead to severe complications.     

Zinc deficiency dermatosis in premature infants receiving prolonged parenteral alimentation

Zinc deficiency dermatitis is a recognized complication of prolonged total parenteral nutrition (TPN) in adults and children. Ten cases of a characteristic dermatosis developing in premature infants with hypozincemia while on long-term TPN are described. The infants presented a defined group of premature neonates who were born between 25 and 28 weeks' gestation with birth weights of less than 1,200 gm and who had received continuous prolonged TPN. The characteristic skin changes appeared on an average of 91 days after birth, with prominent and early involvement of the neck fold crease. Lesions also occurred on the cheeks, buttocks, and genitalia, but spared the extremities. In seven of the ten cases, the skin changes and low serum zinc levels developed 1 to 5 days after an episode of bacterial sepsis or signs of physiologic stress.     

Acquired zinc deficiency in a breast-fed premature infant

Zinc deficiency that was diagnosed at 14 weeks of age developed in a breast-fed premature infant. There was a rapid response to zinc supplements (20 mg/day) and therapy was stopped after three weeks without recurrent disease. The maternal breast milk had a low level of zinc and this could not be corrected by oral zinc supplements.     

Transient zinc deficiency in a breast-fed premature infant

Symptomatic zinc deficiency developed in a breast-fed premature male infant of 31 weeks gestation. At 13 weeks of age he presented with diarrhoea, irritability and an eruption identical to acrodermatitis enteropathica. Breast milk zinc concentrations were low. His course was complicated by milk protein intolerance. After 7 weeks, zinc supplementation was ceased without recurrence of disease.     

Acquired zinc deficiency in two breast-fed mature infants

Zinc deficiency was diagnosed in a breast-fed mature infant and her sister. In both infants the characteristic dermatitis appeared on the face and buttocks around 10 weeks of age. It responded rapidly to zinc supplements. Their mother's serum zinc level was slightly low but her milk was found to be remarkably low in zinc. Oral zinc supplementation could correct only her serum zinc level but not her low breast milk zinc level. Therefore the mother's deficiency in the transfer process of zinc from serum to breast milk was suspected as a cause of the skin changes in her children. These cases indicate that even mature infants, who feed exclusively on mother's milk, run a risk to develop zinc deficiency, if the concentration of zinc in the breast milk is very low.     

Acrodermatitis enteropathica: an uncommon differential diagnosis in childhood – first description of a new sequence variant

An 11‐month‐old boy was brought to our clinic with superinfected, sharply‐defined, symmetrical, erythematous macules and vesicles, some with yellowish‐brownish crusts, on the cheeks, fingers, and in the diaper region. The suspected impetigo contagiosa had failed to respond to both topical antiseptic therapy and systemic antibiotics. Because of the unusual clinical picture and course, we measured the serum zinc level. A significantly reduced level of 2 μmol/l (normal range 9.2–18.4 μmol/l) was identified. Initial skin lesions had appeared one week after weaning (5th week after birth). Since the age of 8 months the infant had also had recurrent diarrhea. Two weeks after zinc‐histidine substitution, the diarrhea ceased and skin lesions slowly disappeared. Molecular genetic testing for the SLC39A4 (zinc transporter) gene revealed compound heterozygosity for the previously unidentified mutations c.1465_1474+4del (p.?) and c.295G>A (p.Ala99Thr). The parents are healthy heterozygous gene carriers. The same compound heterozygosity was later detected in the newborn brother of our patient shortly after birth. A zinc deficiency could therefore be identified and treated before symptoms occurred. The inherited autosomal recessive zinc transporter deficiency is termed acrodermatitis enteropathica. Lifelong zinc substitution is recommended. A differential diagnosis can be difficult because bacterial and fungal superinfection is common in zinc deficiency. Precise diagnosis requires testing family members for the gene.     

HIV感染妇女分娩婴儿低出生体质量情况及影响因素分析

目的了解HIV感染妇女分娩婴儿的出生体质量及其影响因素,为HIV感染妇女的孕期保健提供指导依据。方法分析云南省5个艾滋病高、中流行县(市/区)HIV感染妇女分娩的156例婴儿的出生体质量,采用现况研究方法对其影响因素进行分析。结果共调查155例HIV感染母亲,低出生体质量发生率为14.74%(23/156),早产率为5.13%(8/156),在足月分娩的新生儿中,低出生体质量发生率高达10.14%(15/148)。早产(OR=18.0,95%CI:4.803～67.459)和妊娠期贫血(OR=3.784,95%CI:2.236～12.373)是造成HIV感染妇女分娩婴儿低出生体质量的重要影响因素。结论孕妇感染HIV病毒会造成早产与低出生体质量的机会增加,应加强HIV感染妇女的孕期保健指导。     

Transient Zinc Deficiency in Two Full-term Breast-fed Siblings Associated with Low Maternal Breast Milk Zinc Concentration

Symptomatic zinc deficiency developed in an exclusively breast-fed, full-term infant. Her older brother had also developed zinc deficiency while being exclusively breast-fed. Breast milk zinc concentrations were low throughout lactation, and this inadequacy is the likely cause of the deficiency in both infants.     

Transient zinc deficiency in a breast fed, premature infant

A 5-month-old-male was observed for an acrodermatitis enteropathica-like skin eruption evolving since the second month. He was born prematurely at 27 weeks and his neonatal course was complicated by respiratory distress syndrome, sepsis and subependimary haemorrhage. He was fed with breast milk from the second day of life, fortified initially by a protein mineral supplement containing zinc. Serum zinc concentration was low and the mother's serum and milk had normal zinc values. Oral zinc supplementation was introduced with total clearing after three weeks. Treatment lasted 22 months and no relapse was observed after discontinuation. Premature infants have a negative zinc balance mainly secondary to inadequate stores and high requirements. The relevance of these factors is illustrated by the present case where symptomatic zinc deficiency developed despite maternal milk with normal zinc content and a milk fortifier containing zinc.     

Transient Zinc Deficiency in a Full-Term Breast-Fed Infant of Normal Birth Weight

A full-term male infant was seen at age 5 months with symptomatic zinc deficiency. He was breast fed and the mother's milk zinc levels were low. The infant responded to oral zinc supplements and has continued to be asymptomatic for 12 months after their withdrawal. This is the first report of transient zinc deficiency in an otherwise healthy, breast-fed, full-term infant of normal birth weight.     

Unique presentation of transient zinc deficiency from low maternal breast milk zinc levels

We report full‐term siblings with a unique clinical presentation of polycyclic papulosquamous plaques secondary to transient zinc deficiency due to low maternal breast milk zinc levels. We present this case to highlight this unique presentation of zinc deficiency in breastfed infants.     

Transient symptomatic zinc deficiency in a breast-fed preterm infant

Abstract:  Transient, symptomatic zinc deficiency in breast-fed, low-birthweight infants is a rare, but probably underrecognized disorder hallmarked by periorificial and acral dermatitis. Unlike in acrodermatitis enteropathica, symptoms disappear when nursing ends. We report a breast-fed, preterm infant with demarcated, erythematous, and exudative patches with overlying crusts on the perioral, perianal, and acral areas. Laboratory investigations revealed lowered zinc levels in the infant's serum, but normal levels in his mother's milk. Oral zinc supplementation resulted in total clearing of skin lesions within 4 weeks. Our patient's presentation illustrates the importance of zinc in rapidly growing preterm infants and aims to stimulate awareness for this disorder. Symptomatic zinc deficiency can be easily diagnosed by careful examination and effectively treated with oral zinc substitution.     

Acrodermatitis enteropathica in full-term breast-fed infant

BACKGROUND: Acrodermatitis enteropathica is a rare autosomal recessive disorder, caused by impaired absorption of zinc from the gastrointestinal tract. Symptoms of acrodermatitis enteropathica occur within the first few months after birth and tend to appear shortly after discontinuation of breast-feeding. We report a breast-fed infant with acrodermatitis enteropathica. CASE REPORT: A full term, 4-month-old girl, consulted in dermatologic department for persistent and refractory anogenital lesions since the age of 1 month, with progressive erythematous, vesiculous and squamous lesions, sometimes erosive in a peri orificial and acral pattern. She was calm and healthy baby. She was breast feeding. The diagnosis of acrodermatitis enteropathica was confirmed by decreased plasma zinc level (14 microg/100 ml). Breast milk zinc levels was low (46 microg/100 ml), as plasma zinc level of the mother (94 microg/100 ml). A genetic study showed that she was homozygous for the mutation, whereas her brother and parents were heterozygous. She was given zinc sulphate, and her condition has improved significantly. DISCUSSION: Acrodermatitis enteropathica is characterized by a characteristic clinical feature and the diagnosis is confirmed by decreased plasma zinc level. Acrodermatitis enteropathica in exclusively breast fed infant is rare, it was essentially reported in premature babies. Our case report is particular because it's concerning a full-term breast-fed infant, with zinc deficiency in breast milk and mother's decreased plasma zinc level.     

Invasive fungal dermatitis in extremely premature newborns: a specific clinical form of systemic candidiasis

BACKGROUND: Fungal agents, chiefly Candida albicans, are the cause of rising morbidity and mortality in newborn infants weighing less than 1500 g. We studied the particular cutaneous effects during the course of these infections. PATIENTS AND METHODS: This was a retrospective 3-year study in premature infants weighing less than 1500 g and hospitalized in the neonatal department of the Lille University Teaching Hospital. The patients included in the study presented sepsis with isolation of Candida in blood and/or urine culture. RESULTS: Twelve infants were included (1.8%). The risk factors seen are those described in literature (broad-spectrum antibiotics, prolonged mechanical ventilation and parenteral nutrition, corticosteroids and central venous catheters). Infection occurred early (mean: D12) and affected extremely premature infants (mean: 25 weeks' amenorrhea) of low birth weight (mean: 758 g) generally born by vaginal delivery (9 of 12 infants). The sole fungal agent isolated was Candida albicans. In 10 of the 12 patients, a characteristic skin disorder was observed (erythema with erosion and desquamation). In 10 of the 12 patients, too, Candida was isolated from skin and/or mucosal samples. DISCUSSION: Although it is now universally accepted that antifungal treatment should be initiated without delay for candidemia in septic newborn infants at risk, diagnosis of systemic candidiasis remains delicate. However, a specific pattern of skin involvement is very commonly seen that is atypical for candidiasis, but which in addition to its diagnostic value indicates early colonization with Candida (first 2 weeks of life). In this setting of immaturity of the skin and immune system, colonization and proliferation in skin and/or mucosa appear to constitute the first stage of systemic infection and we may speak of invasive cutaneous-mucosal candidiasis in extremely premature infants and initiate treatment designed to prevent the disease becoming systemic..     

Hair zinc, scalp hair quantity, and diaper rash in normal infants

Hair zinc concentration was determined by atomic absorption spectrophotometry in 308 normal newborn infants and 199 normal infants aged one to twelve months. Hair zinc concentration declined from 204 micrograms/gm at birth to 112 micrograms/gm at age eight months, and then rose to 144 micrograms/gm at age twelve months. Diaper rash was significantly associated with reduced hair zinc, and infants with the least hair had lower zinc levels than infants with the most hair. The data indicate that hair loss and diaper rash found in normal infants is significantly associated with a reduction in hair zinc concentration.     

A Diagnostic Challenge: A Case of Acrodermatitis Enteropathica without Hypozincemia and with Maternal Milk of Low Zinc Level

Abstract: Acrodermatitis enteropathica is a rare and distinct form of zinc deficiency with a requirement of life‐long zinc supplementation and inherited in a recessive manner. Transient nutritional zinc deficiency is also a well known condition mimicking acrodermatitis enteropathica like skin changes in preterm and term infants who are generally breastfed with a low level of zinc containing milk. Here, a 4‐month‐old male, term and fully breastfed acrodermatitis enteropathica case without hypozincemia and with maternal milk of low zinc level is presented.     

Neonatal intensive care practices and the influence on skin condition

Background Premature skin has a thinner epidermis with a poorly formed stratum corneum (SC) barrier compared to full term skin. Poor skin integrity increases the risk of exposure to irritants and infectious agents. Interventions that facilitate skin maturation are essential. Objective The objective was to examine the effects of prematurity and time from birth on SC maturation and to identify factors that impact skin condition. Methods A retrospective review was conducted among 130 NICU patients. Skin regions were evaluated for erythema, rash, integrity and function. The effects of gestational age, time from birth, stool exposure, nutrition and diagnosis were examined. Results Three groups emerged: (i) premature and <38 weeks adjusted age; (ii) premature and >38 weeks adjusted age; and (iii) full term. Surprisingly, the premature infants exhibited lower perineal irritation and greater SC integrity (lower transepidermal water loss) than full terms (P < 0.05). Group 2 had a longer time before the first skin‐stool contact. Chest skin pH showed maturational changes for Group 1 (P < 0.05) but did not change for premature Group 2 who was older at enrollment. Erythema was lower for infants using elemental formulas or total parenteral nutrition. Conclusions Premature infants with early stool contact and high exposure, full term infants, and patients with congenital diaphragmatic hernia or trisomy 21 are at high risk for skin compromise and may benefit from prophylactic interventions to minimize compromise. Low stool exposure and greater time before the first stool contact appear to be protective against skin compromise.     

Transient zinc deficiency syndrome in a breast-fed infant due to decreased zinc in breast milk (type II hypozincemia of infancy): A case report and review of the literature

Type II hypozincemia of infancy is a rare, hereditary zinc deficiency occurring in infants while exclusively on breast feeding. It is caused by defective transfer of zinc into breast milk. Only a few dozen cases have been reported. A 6-month-old, full-term, breast-fed female infant presented with a 3-week history of erythematous to dusky red papules and annular plaques over the perioral and diaper area as well as the digits. The eruption was accompanied by poor appetite and irritable crying. Serum zinc was low (4.896 μmol/L, normal = 10.71?18.36 μmol/L) in the patient but was normal in the mother. Interestingly, the zinc level in the breast milk was very low (2.142 μmol/L; normal postpartum zinc = 18.36 μmol/L at 6 months). Histopathology of a skin biopsy specimen showed spongiotic psoriasiform dermatitis with pallor of superficial keratinocytes, consistent with deficiency disease. With oral zinc sulfate supplement, her skin lesions improved significantly within 4 days. Type II hypozincemia needs to be differentiated from the classical hereditary acrodermatitis enteropathica, which typically develops symptoms after weaning because of poor intestinal absorption of zinc in the affected infants. Mutations in zinc transporter genes have been detected in SLC39A4 (Zip4) and SLC30A2 (ZnT2), respectively, in classical acrodermatitis enteropathica and type II hypozincemia. No mutation was found in these two genes in the present pedigree. Therefore, the genetic defect in our patient might involve other zinc transporter genes.     

219例妊娠合并梅毒母婴传播阻断疗效的分析

目的探究妊娠合并梅毒感染孕妇母婴阻断对妊娠结局及胎儿预后的影响。方法回顾性分析2015年1月至2017年12月大连医科大学附属妇产医院行孕期产检及分娩时诊断为妊娠合并梅毒的219例病例资料,根据是否进行母婴阻断及阻断的时机,将其分为早期规范干预组(孕周期<28周)187例,晚期规范干预组(28<孕周期≤35周)5例及未干预/未规范干预组(孕周期>35周)27例。观察两组患者的妊娠结局、胎儿预后以及胎儿梅毒血清学实验。结果纳入妊娠合并梅毒219例,其中接受规范化干预的患者192例(87.7%),未发生早产、新生儿死亡、死胎事件,发生先天性梅毒2例(1.0%)。未干预/未规范干预组27例患者中发生先天梅毒6例(22.2%)、早产4例(14.8%)、新生儿死亡2例(7.4%)、死胎4例(14.8%),明显高于规范干预组(P<0.05)。低血清TRUST滴度组妊娠合并梅毒患者均未发生早产、新生儿死亡、死胎,仅发生天性梅毒2例(1.5%)。其中,先天性梅毒、早产、死胎的发生于TRUST滴度成spearman正相关,具有统计学意义(P=0.011、0.023、0.001)。结论孕期规范的青霉素干预可明显避免妊娠合并梅毒患者发生不良妊娠事件。