title: Aluminium exposure from parenteral nutrition in preterm infants and later health outcomes during childhood and adolescence.
abstract: Aluminium is the most common metallic element, but has no known biological role. It accumulates in the body when protective gastrointestinal mechanisms are bypassed, renal function is impaired, or exposure is high - all of which apply frequently to preterm infants. Recognised clinical manifestations of aluminium toxicity include dementia, anaemia and bone disease. Parenteral nutrition (PN) solutions are liable to contamination with aluminium, particularly from acidic solutions in glass vials, notably calcium gluconate. When fed parenterally, infants retain >75% of the aluminium, with high serum, urine and tissue levels. Later health effects of neonatal intravenous aluminium exposure were investigated in a randomised trial comparing standard PN solutions with solutions specially sourced for low aluminium content. Preterm infants exposed for >10 d to standard solutions had impaired neurologic development at 18 months. At 13-15 years, subjects randomised to standard PN had lower lumbar spine bone mass; and, in non-randomised analyses, those with neonatal aluminium intake above the median had lower hip bone mass. Given the sizeable number of infants undergoing intensive care and still exposed to aluminium via PN, these findings have contemporary relevance. Until recently, little progress had been made on reducing aluminium exposure, and meeting Food and Drug Administration recommendations (<5 μg/kg per d) has been impossible in patients <50 kg using available products. Recent advice from the UK Medicines and Healthcare regulatory Authority that calcium gluconate in small volume glass containers should not be used for repeated treatment in children <18 years, including preparation of PN, is an important step towards addressing this problem.
authors.affiliation: Childhood Nutrition Research Centre, UCL Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK. m.fewtrell@ich.ucl.ac.uk
authors.forename: Mary S
authors.initials: MS
authors.lastname: Fewtrell
authors.forename: Caroline J
authors.initials: CJ
authors.lastname: Edmonds
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Isaacs
authors.forename: Nick J
authors.initials: NJ
authors.lastname: Bishop
authors.forename: Alan
authors.initials: A
authors.lastname: Lucas
mesh_terms: D000293:Adolescent; D000535:Aluminum / Q000378:metabolism / Q000633:toxicity*; D015519:Bone Density / Q000187:drug effects*; D004311:Double-Blind Method; D004784:Environmental Monitoring; D005500:Follow-Up Studies; D005506:Food Contamination; D006128:Growth / Q000187:drug effects; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature / Q000254:growth & development*; D009420:Nervous System / Q000187:drug effects / Q000254:growth & development; D009422:Nervous System Diseases / Q000139:chemically induced*; D010288:Parenteral Nutrition / Q000009:adverse effects*; D057947:Parenteral Nutrition Solutions / Q000009:adverse effects / Q000737:chemistry
chemical_list: D057947:Parenteral Nutrition Solutions; D000535:Aluminum