Related Experiment Video
Updated: Jun 13, 2026
Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Aluminum loading in preterm neonates revisited
Denise Bohrer1, Sandra M R Oliveira, Solange C Garcia
1Department of Chemistry, Universidade Federal de Santa Maria, Santa Maria, RS, Brazil. ndenise@quimica.ufsm.br
Insights
Preterm infants receiving parenteral nutrition accumulate aluminum (Al) due to contamination. Studies show neonates exceed safe Al intake limits, with over half of the intake not excreted, indicating potential toxicity.
Area of Science:
- Neonatal Medicine
- Toxicology
- Clinical Chemistry
Background:
- Parenteral nutrition (PN) is essential for preterm neonates but carries a risk of aluminum (Al) overload.
- Aluminum contamination in PN formulations persists despite regulatory efforts by the US Food and Drug Administration (FDA).
- Preterm infants are particularly vulnerable to Al toxicity due to immature organ function.
Purpose of the Study:
- To re-evaluate aluminum exposure and balance in preterm neonates receiving total parenteral nutrition (TPN) in the NICU.
- To quantify aluminum intake versus urinary excretion to assess net retention.
- To compare measured aluminum intake against established safe limits.
Main Methods:
- Prospective study involving 10 preterm neonates in the NICU receiving TPN.
- Daily collection and analysis of PN solutions for aluminum content using atomic absorption spectrometry.
- Daily urine collection for aluminum excretion measurement and blood sampling on admission and discharge for serum aluminum levels.
Main Results:
- A significant portion, 56.2% +/- 22.7%, of administered aluminum intake was not excreted by the neonates.
- Mean serum aluminum levels decreased from 41.2 +/- 23.3 microg/L on admission to 23.5 +/- 11.2 microg/L on discharge.
- The average daily aluminum intake was 15.2 +/- 8.0 microg x kg(-1) x day(-1), approximately three times the FDA's safe limit of 5 microg x kg(-1) x day(-1).
Conclusions:
- Preterm neonates receiving TPN experience significant aluminum retention, indicating potential for cumulative toxicity.
- Current aluminum contamination levels in PN formulations exceed FDA safety guidelines for this vulnerable population.
- The observed decrease in serum aluminum levels alongside positive balance suggests tissue deposition rather than rapid elimination.
Abstract:
Preterm neonates receiving parenteral nutrition are at risk of aluminum (Al) overload because of the presence of Al as a contaminant in parenteral formulations. Despite US Food and Drug Administration regulation, commercial products continue to present Al contamination. To reassess Al exposure in the premature neonatal population, the present study evaluated the Al balance (intake vs urinary excretion) in a group of preterm neonates during the period in which they stayed in the intensive care unit (NICU) under total parenteral nutrition. For the 10 patients selected, daily infusion solutions (nutrition and medication) were collected and the level of Al contamination was measured. From the urine collected daily, an aliquot was taken for Al determination. Blood was also collected for Al determination on the first and last day in the NICU. The measurements were carried out by atomic absorption spectrometry. The difference between Al administered and excreted revealed that 56.2% +/- 22.7% of the Al intake was not eliminated. The mean serum Al levels from the first to the last day decreased from 41.2 +/- 23.3 to 23.5 +/- 11.2 microg/L. The resulting mean Al daily intake of the 10 patients was 15.2 +/- 8.0 microg x kg(-1) x day(-1). Because Al intake was higher than that excreted and Al in serum decreased to practically half during the period in the NICU (+/-7.3 days), some amount of Al deposition occurred. Moreover, premature neonates were receiving, on average, 3 times the amount of 5 microg x kg(-1) x day(-1), considered by the Food and Drug Administration as a safe limit.
Related Concept Videos
01:17Pharmacokinetics in Pediatric Patients: Drug Distribution
01:29Drug Dosing: Infants and Children