title: Impact of the Nationwide Intravenous Selenium Product Shortage on the Development of Selenium Deficiency in Infants Dependent on Long-Term Parenteral Nutrition.
abstract: For patients dependent on parenteral nutrition (PN), selenium must be supplemented intravenously. A nationwide intravenous selenium shortage began in April 2011. The impact of this shortage on PN-dependent infants was evaluated by examining the provision of selenium, development of biochemical deficiency, and costs associated with the shortage.
  
  
  
  This single-center, retrospective study included PN-dependent infants aged ≤1 year who weighed ≤30 kg, received PN for ≥1 month, and had ≥1 serum selenium measurement. The primary outcome was the incidence of biochemical selenium deficiency. Secondary outcomes included severity of biochemical deficiency, clinical manifestations, costs, and relationship between serum selenium levels and selenium dose.
  
  
  
  The average selenium dose decreased 2-fold during the shortage (2.1 ± 1.2 µg/kg/d; range, 0.2-4.6 µg/kg/d) versus the nonshortage period (3.8 ± 1 µg/kg/d; range, 2.4-6 µg/kg/d; P < .001). A linear relationship between serum selenium concentration and selenium dose was observed (r(2) = 0.42), with a dose of 6 µg/kg/d expected to result in normal serum levels in most cases. Similar proportions of patients developed biochemical deficiency in both groups: shortage period, 59.1%; nonshortage, 66.7%; P = .13. The severity of biochemical deficiency was similar between groups. A significant increase in incremental cost during the shortage was observed.
  
  
  
  This is the first study examining the impact of the intravenous selenium shortage on PN-dependent infants. Both groups exhibited similarly high incidences of biochemical selenium deficiency, suggesting higher empiric doses may benefit this population. However, ongoing shortages limit the ability to provide supplementation.
authors.affiliation: College of Pharmacy, University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: Connie H
authors.initials: CH
authors.lastname: Chen
authors.affiliation: Children's Intestinal Rehabilitation Program, University of Michigan C.S. Mott Children's Hospital, Patient Food and Nutrition Services, Ann Arbor, Michigan, USA.
authors.forename: Mary Beth
authors.initials: MB
authors.lastname: Harris
authors.affiliation: Intestinal Rehabilitation/Homemed, College of Pharmacy, The University of Michigan Health Systems, C.S. Mott Children's and Women's Hospital, Ann Arbor, Michigan, USA.
authors.forename: M Luisa
authors.initials: ML
authors.lastname: Partipilo
authors.affiliation: Center for Statistical Consultation and Research, The University of Michigan School of Public Health, Ann Arbor, Michigan, USA.
authors.forename: Kathleen B
authors.initials: KB
authors.lastname: Welch
authors.affiliation: Section of Pediatric Surgery, Department of Surgery, C.S. Mott Children's Hospital, The University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Teitelbaum
authors.affiliation: Pediatric Surgery, The University of Michigan College of Pharmacy, Department of Clinical, Social and Administrative Sciences, Ann Arbor, Michigan, USA The University of Michigan Health System, Department of Pharmacy Services, Ann Arbor, Michigan, USA allison.blackmer@ucdenver.edu.
authors.forename: Allison B
authors.initials: AB
authors.lastname: Blackmer
mesh_terms: D005260:Female; D006801:Humans; D007223:Infant; D007227:Infant Nutritional Physiological Phenomena; D007231:Infant, Newborn; D008297:Male; D057947:Parenteral Nutrition Solutions / Q000737:chemistry* / Q000191:economics / Q000600:supply & distribution*; D012189:Retrospective Studies; D012643:Selenium / Q000008:administration & dosage / Q000097:blood / Q000172:deficiency*
chemical_list: D057947:Parenteral Nutrition Solutions; D012643:Selenium
keywords: deficiency; parenteral nutrition; pediatric; selenium; shortage