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Response of preterm infants to aluminum in parenteral nutrition
W W Koo1, L A Kaplan, S K Krug-Wispe
1University of Alberta, Walter Mackenzie Health Science Center, Edmonton, Canada.
Insights
Preterm infants receiving parenteral nutrition (PN) show increased urine aluminum (Al) excretion with higher Al loads. However, excretion is incomplete, leading to bone deposition and elevated serum Al levels.
Area of Science:
- Neonatal Medicine
- Toxicology
- Nutritional Science
Background:
- Parenteral nutrition (PN) solutions can contain unavoidable aluminum (Al) contamination.
- Preterm infants, especially those with very low birth weight (VLBW), are at risk for Al accumulation due to immature renal function.
Purpose of the Study:
- To investigate the response of preterm infants to two different levels of aluminum loading from PN solutions.
- To assess aluminum excretion and accumulation in preterm neonates.
Main Methods:
- Twenty-five preterm infants (gestational age 24-37 weeks, birth weight 540-2280 g) were divided into high (H) and low (L) Al loading groups.
- Urine and serum aluminum (Al) concentrations and urine Al:Creatinine ratios were measured.
- Bone tissue analysis was performed in one deceased infant.
Main Results:
- Urine Al:Creatinine ratios were significantly higher in the high Al loading group.
- Serum Al concentrations remained elevated above the normal median in both groups throughout the study.
- Urine Al excretion was incomplete, with 34% (H group) and 28% (L group) of the load excreted.
- One infant showed Al deposition in bone and excessive unmineralized osteoid.
Conclusions:
- Preterm infants can increase urine Al excretion in response to higher Al loads from PN.
- Aluminum excretion is incomplete, leading to persistent elevated serum Al and potential bone accumulation.
- Careful monitoring of Al content in PN solutions is crucial for preterm infants.
Abstract:
Twenty-five preterm infants with birth weights (BW) 540 to 2280 g (20 with birth weight less than 1500 g) and gestational ages 24 to 37 weeks, were studied to determine the response to 2 levels of aluminum (Al) loading from currently unavoidable contamination of various components of parenteral nutrition (PN) solution. High Al loading group (H) received solutions with measured Al content of 306 +/- 16 micrograms/liter and low A1 loading group (L) received solutions with 144 +/- 16 micrograms A1/liter. Urine Al:Creatinine (Al:Cr) ratios (micrograms:mg) became elevated and significantly higher in H (1.6 +/- 0.38 vs 0.5 +/- 0.1, p less than 0.05) at the third sampling point (mean 19 days). Serum Al concentrations were highest at onset in both groups and stabilized with study but remained consistently higher than the normal median of 18 micrograms/liter. Calculated urine Al excretion were consistently low and were 34 +/- 6% vs 28 +/- 5% in the H and L groups, respectively. One infant in the L group who died 39 days after termination of above study showed the presence of A1 in bone trabeculae and the presence of excessive unmineralized osteoid along the trabeculae. We conclude that small preterm infants are able to increase urine Al excretion with increased Al load. However urine Al excretion is incomplete with bone deposition of Al and persistently elevated serum Al concentrations.