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Zinc Deficiency-Associated Dermatitis Among Infants After Nationwide Shortage of Injectable Zinc — District of Columbia and Texas, 2012–2013

Wednesday, June 12, 2013: 10:30 AM
Ballroom F (Pasadena Convention Center)
Duke J. Ruktanonchai , Centers for Disease Control and Prevention, Austin, TX
Tiana A. Garrett , Centers for Disease Control and Prevention, Washington, DC
Michael Lowe , Centers for Disease Control and Prevention, Atlanta, GA
Scott A. Norton , Children's National Medical Center, Washington, DC
Lamia Soghier , Children's National Medical Center, Washington, DC
Billie Lou Short , Children's National Medical Center, Washington, DC
Steven Abrams , Baylor College of Medicine, Houston, TX
Jeffrey A. Lapinski , Children's National Medical Center, Washington, DC
June Hatfield , Children's National Medical Center, Washington, DC
Wanda Barfield , Centers for Disease Control and Prevention, Atlanta, GA

BACKGROUND:   Shortages of parenteral micronutrients (e.g., zinc, selenium, and multivitamins) have led to clinically significant deficiencies in certain infants dependent on parenteral nutrition. In December 2012, three premature infants in the District of Columbia experienced dermatitis in the diaper region and blisters on their extremities. In Texas, a term infant who had bowel obstruction experienced dermatitis and alopecia. All four infants were dependent on total parenteral nutrition (TPN) and subsequently had diagnoses of zinc deficiency. We investigated to characterize the illness.

METHODS:   Neonatologists who reported the initial cases completed a case report form for each infant with zinc deficiency. A zinc deficiency case was defined as an infant who had received TPN and had low plasma zinc levels, dermatitis consistent with zinc deficiency, or low alkaline phosphatase levels, a zinc-dependent enzyme, during December 2012–January 2013. We collaborated with the American Academy of Pediatrics (AAP) in contacting U.S. hospitals through their listserv to identify additional cases.

RESULTS:   Seven infants were identified with zinc deficiency from Texas and the District of Columbia. Five had been born premature (median gestational age: 29 weeks; range: 24–37.9). Five (71%) were male, and three (43%) were non-Hispanic black. Six (86%) had dermatitis, and two (29%) experienced bacterial infections. One infant died from liver failure. No additional cases were reported. In January 2013, the Food and Drug Administration was able to facilitate emergency shipment of injectable zinc to hospitals. All six surviving infants improved after receiving zinc.

CONCLUSIONS:   A nationwide shortage of injectable zinc reduced the amount of zinc supplement available for inclusion in TPN. These cases underscore the need for increased efforts to monitor adverse events during zinc shortages.

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