With the increasing survival of extremely low-birthweight or very preterm infants, it is becoming increasingly important to understand micronutrient needs. Most fetal accretion of zinc occurs in the third trimester, when liver stores are laid down, putting these babies at risk of clinical deficiency. It remains difficult to monitor zinc concentrations without clear reference ranges, but some evidence can guide requirements to avoid deficiency. It is not clear whether matching fetal accretion is necessary or whether increasing zinc balance improves short- or long-term outcomes in preterm infants. Given the increasing knowledge, it is possible to make recommendations on the amount of zinc that should be provided, whether by the parenteral or enteral route, in human or formula milk to the smallest babies.

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