Aluminium in the neonate related to parenteral nutrition

Abstract

Sources of aluminium loading and exposure in preterm and full-term newborns were studied. Parenteral nutrition solutions were the main source of aluminium representing 88.7% of total aluminium intake. Blood and urine aluminium levels were followed over a 28-day period in a group of 26 preterm and 9 term infants while receiving parenteral nutrition (duration 15.6 +/- 8.7 days) and later when being formula fed. Urine levels were followed up to 13 weeks in a subgroup of the neonates. Serum aluminium levels (0.86 +/- 0.38 mumol/l) and urine aluminium/creatinine ratio (1.52 +/- 0.81 mumol/mmol) were increased when the infants were receiving parenteral nutrition compared with the control group (p < 0.001). The urine aluminium/creatinine ratio remained high up to 10 weeks following withdrawal of parenteral nutrition and suggested tissular loading. This was confirmed after high aluminium levels were found in post-mortem brain and bone samples from two preterm and one full-term infant. We conclude that both preterm and full-term neonates are susceptible to accumulation of aluminium in tissue while receiving parenteral nutrition.

Aluminum Exposure From Parenteral Nutrition in Preterm Infants: Bone Health at 15-Year Follow-up

“…When fed parenterally, infants retain up to 78% of the aluminum 4 , with high serum, urine and tissue levels 1 . Increased aluminum concentrations have been observed post mortem in the brain of a parentally fed preterm infant 5 .…”

Reduced aluminum contamination decreases parenteral nutrition associated liver injury

“…However, there are no such limits for small-volume parenterals, and these are the main source of aluminum in PN. As a result, a typical infant PN therapy results in aluminum contamination levels of 10 to 60 μg kg −1 d −1 [3,7,26,27]. This is well in excess of the toxicity warnings of the Food and Drug Administration.…”

Severe neonatal hypercalcemia secondary to Aluminium toxicity

“…Aluminium hydroxide gel in the antacid caused raised aluminium level, which was further contributed by parenteral nutrition. 3 Tsou, et al studied 10 infants, who had consumed antacids for at least 1 week, while 16 infants without receiving antacids acted as control population. 5 Plasma aluminium level (37.2±7.13 µg/L) in the study group was significantly higher than that of the control group (4.13±0.66 µg/L) (P <0.005).…”

“…2 NICU babies are exposed to it through parenteral nutrition. 3 FDA has recommended that aluminium in parenteral nutrition should be <25 meq/Lit. Albumin solution and calcium gluconate solution in glass vials are also some of the sources.…”