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CDC reports zinc deficiency-associated dermatitis in infants

Infants hospitalized with cholestasis experienced erosive dermatitis after receiving zinc-deficient parenteral nutrition formulations, according to a report from the CDC.

Researchers reported on three premature infants with extreme cholestasis at a Washington, DC, hospital in December 2012. All experienced erosive dermatitis of the diaper area and blisters on extremities, and the patients, unable to be fed by mouth or tube, received parenteral nutrition (PN) formulations that were zinc deficient.

“Injectable zinc is normally added to PN for premature or medically compromised infants (eg, those with cholestasis) by hospital pharmacy; however, the pharmacy had run out of injectable zinc,” the researchers wrote. “No alternatives were available.”

One infant had symptoms resolve after being able to ingest nutrition, while the other two had low serum zinc levels.

Four additional cases of zinc deficiency in infants with cholestasis who received zinc-deficient PN at a Houston hospital were reported to the CDC in January 2013.

Low serum zinc levels were reported for six of the seven patients (range, 14-56 mcg/dL [normal 70-120 mcg/dL]), as well as low alkaline phosphatase levels (range, 32-125 U/L [normal: 150-420 U/L]). Both hospitals obtained emergency shipments of injectable zinc after collaborating with the FDA.

“Current injectable zinc supplies have been increasing as FDA collaborates with pharmaceutical companies to import emergency supplies,” the researchers reported. “FDA is working to establish temporary backup sources should future shortages occur.

“Physicians who prescribe PN should recognize the potential risks for micronutrient deficiency, including zinc deficiency, among premature infants who require increased amounts or are unable to receive adequate doses,” the researchers concluded. “During shortages, clinicians might need to reserve micronutrients for the most vulnerable populations.”

According to the FDA, shortages also exist for selenium, chromium and copper, and the agency is coordinating with manufacturers to prioritize production and identify other micronutrient sources.

Disclosure: Relevant financial disclosures were not provided by researchers.