Keywords
Sepsis
Zinc
How to Cite
Abstract
Background: Sepsis is one of the most common causes of morbidity and mortality in young children. Zinc supplementation has a preventive effect against diarrhoeal diseases and respiratory infections, but little is known about its effect on the treatment of sepsis.
Objectives: To evaluate the benefit of oral Zinc supplementation along with standard antimicrobial therapy in childhood sepsis.
Methods: A randomised, double-blind controlled trial was conducted on 164 septic children between 1-15 years of age from 15th April 2017 to 14th April 2018 in a eastern Nepal tertiary care centre. Block randomisation was done with four participants in each block. There were 21 and 20 blocks in the intervention and in the placebo group respectively. Each child received oral zinc (20 mg elemental zinc/day) or a placebo once a day for 14 days. Percentage was calculated for descriptive statistics and Chi-square for inferential statistics with 95% CI and p <0.05 for data analysis using SPSS v.16.
Results: Of the participants, 84 (51.21%) received Zinc and 80 (48.79%) received a placebo in adjunct to the standard antimicrobial therapy. Most of the children 76 (46.34%) were under five years and were male 98 (59.75%), and 69 (42.07%) were underweight. Those receiving zinc and placebo had similar improvements at discharge; there was no reduction in the need for higher-order antibiotics or in the length of PICU/ hospital stay. Zinc supplementation in childhood sepsis had no benefit on decreasing mortality or decreasing severity (p >0.05).
Conclusion: Zinc supplementation during childhood sepsis does not help in short-term clinical recovery.
References
Goldstein B, Giroir B, Randolph A. International paediatrics sepsis consensus conference: Definitions for sepsis and organ dysfunction in Paediatrics. Pediatr Crit Care Med. 2005;6(1):2-8. [PubMed | Full Text | DOI]
Weiss SL, Peters MJ, Alhazzani W, Agus MSD, Flori HR, Inwald DP, et al. Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children. Paediatr Crit Care Med. 2020;2(21):e52-e106. [PubMed | Full Text | DOI]
NICE. National Institute for Health and Care Excellence: Sepsis: recognition, diagnosis and early management (NICE Guideline 51). 2016. [PubMed | Full Text]
Wiens MO, Kumnakumba E, Kissoon, Ansermino JM, Ndamira A, Larson CP. Paediatrics sepsis in the developing world: challenges in defining sepsis and issues in post-discharge mortality. Clin Epidemiol. 2012;4:319-25. [PubMed | Full Text | DOI]
Shankar AH, Prasad AS. Zinc and immune function: the biological basis of altered resistance to infection. Am J Clin Nutr. 1998 Aug;68(2 Suppl):447S-463S. [PubMed | Full Text | DOI]
Banupriya N, Kalaivani S, Benet Bosco D, Vishnu B. Zinc supplementation in paediatrics practice. J Pediatr Sci. 2015;7:e240. [Full Text | DOI]
Prasad AS. Clinical. Immunological, antiinflammatory and antioxidant roles of zinc. Exp Gerontology 2008; 43:370-7. [PubMed | Full Text | DOI]
Lazzerini M, Ronfani L. Oral zinc for treating diarrhoea in children. Cochrane Database Syst Rev. 2008 Jul 16;(3):CD005436. [PubMed | Full Text | DOI]
Bhatnagar S, Natchu UCM. Zinc in child health and disease. Indian J Pediatr. 2004;71:991-5. [PubMed | Full Text | DOI]
Bansal A, Parmar VR, Basu S, Kaur J, Jain S, Saha A, et al. Zinc supplementation in severe acute lower respiratory tract infection in children: a tripleblind randomized placebo controlled trial. Indian J Pediatr. 2011 Jan;78(1):33-7. [PubMed | Full Text | DOI]
Nepal AK, Gelal B, Mehta K, Lamsal M, Pokharel PK, Baral N. Plasma zinc levels, anthropometric and socio-demographic characteristics of school children in eastern Nepal. BMC Res Notes. 2014 Jan 9;7:18. [PubMed | Full Text | DOI]
Roth DE, Richard SA, Black RE. Zinc supplementation for the prevention of acute lower respiratory infection in children in developing countries: metaanalysis and meta-regression of randomized trials. Int J Epidemiol. 2010; 39:795-808. [PubMed | Full Text | DOI]
Brooks WA, Yunus M, Santosham M, Wahed MA, Nahar K, Yeasmin S, et al. Zinc for severe pneumonia in very young children: Double-blind placebocontrolled trial. Lancet. 2004 May 22;363(9422):1683- 8. [PubMed | Full Text | DOI]
Basnet S, Shrestha PS, Sharma A, Mathisen M, Prasai R, Bhandari N, et al. A randomized controlled trial of zinc as adjuvant therapy for severe pneumonia in young children. Pediatrics. 2012 Apr;129(4):701-8. [PubMed | Full Text | DOI]
Chang AB, Torzillo PJ, Boyce NC, White AV, Stewart PM, Wheaton GR, et al. Zinc and vitamin A supplementation in indigenous Australian children hospitalized with lower respiratory tract infection: a randomised controlled trial. Med J Aust. 2006 Feb 6;184(3):107-12. [PubMed | Full Text | DOI]
Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, et al. Surviving sepsis campaign: International guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med. 2013 Feb;41(2):580-637. [PubMed | Full Text | DOI]
Rhodes A, Evans LE, Alhazzani W, Levy MM, Antoneli M, Ferrer R, et al. Surviving sepsis campaign: International guidelines for management of sepsis and septic shock: 2016. Crit Care Med. 2017 Mar;45(3):486-552. [PubMed | Full Text | DOI]
Vincent JL, de Mendonça A, Cantraine F, Moreno R, Takala J, Suter PM, et al. Use of the SOFA score to assess the incidence of organ dysfunction/failure in intensive care units: results of a multicenter, prospective study. Working group on “sepsis-related problems” of the European Society of Intensive Care Medicine. Crit Care Med. 1998 Nov;26(11):1793-800. [PubMed | Full Text | DOI]
Iwashyna TJ, Ely EW, Smith DM, Langa KM. Longterm cognitive impairment and functional disability among survivors of severe sepsis. JAMA. 2010 Oct 27;304(16):1787-94. [PubMed | Full Text | DOI]
Ministry of Health, Nepal; New ERA; and ICF. 2017. Nepal Demographic and Health Survey 2016. Kathmandu, Nepal: Ministry of Health, Nepal. [FullText]
Valentiner-Branth P, Shrestha PS, Chandyo RK, Mathisen M, Basnet S, Bhandari N, et al. A randomized controlled trial of the effect of zinc as adjuvant therapy in children 2-35 mo of age with severe or non severe pneumonia in Bhaktapur, Nepal. Am J Clin Nutr. 2010 Jun;91(6):1667-74. [PubMed | Full Text | DOI]
Shah GS, Dutta AK, Shah D, Mishra OP. Role of zinc in severe pneumonia: A randomized double bind placebo-controlled study. Ital J Pediatr. 2012;8:36. [PubMed | Full Text | DOI]
Wadhwa N, Chandran A, Aneja S, Lodha R, Kabra SK, Chaturvedi MK, et al. Efficacy of zinc given as an adjunct in the treatment of severe and very severe pneumonia in hospitalized children 2-24 mo of age: a randomized, double-blind, placebo-controlled trial. Am J Clin Nutr. 2013 Jun;97(6):1387-94. [PubMed | Full Text | DOI]
Mehta K, Bhatta NK, Majhi S, Shrivastava MK, Singh RR. Oral Zinc supplementation for reducing mortality in probable neonatal sepsis: A double blind randomized placebo-controlled trial. Indian Pediatr. 2013; 50:390-3. [PubMed | Full Text | DOI]
Bhutta ZA, Black RE, Brown KH, Gardner JM, Gore S, Hidayat A. (Zinc Investigator/ Collaborative Group). Prevention of diarrhoea and pneumonia by zinc supplementation in children in developing countries: Pooled analysis of randomized controlled trials. J Pediatr. 1999;135:689-97. [PubMed | Full Text | DOI]
Chandra U, Natchu, M, Fataki MR, Fawzi WW. Zinc as an adjunct for childhood pneumonia - interpreting early results. Nutrition Reviews Vol. 66(7):398-405. [PubMed | Full Text | DOI]