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Infant formula as a cause of aluminium toxicity in neonatal uraemia
Insights
Infant milk formula can be a source of aluminium toxicity in infants with congenital uraemia. Using aluminium-free milk may help prevent this serious condition in vulnerable newborns.
Area of Science:
- Pediatric Nephrology
- Toxicology
- Infant Nutrition
Background:
- Congenital uraemia presents significant challenges in infant care.
- Aluminium toxicity is a serious concern in infants with renal failure.
Observation:
- Two infants with congenital uraemia developed aluminium toxicity despite no exposure to common sources.
- Neurological symptoms and high brain aluminium concentrations were observed in both infants.
- Bone aluminium levels and histology were normal, suggesting a non-skeletal source.
Findings:
- Analysis revealed significantly high aluminium levels in a proprietary infant milk formula ('Similac PM 60/40').
- Sterilised water and dialysate concentrate showed negligible aluminium concentrations.
- The powdered milk formula was identified as the likely source of aluminium exposure.
Implications:
- Proprietary infant milk formulas represent an unrecognized source of aluminium for infants with renal failure.
- Switching to aluminium-free milk formulas is crucial for preventing aluminium toxicity in this high-risk population.
- This highlights the need for careful formulation review of infant nutritional products for vulnerable infants.
Abstract:
Aluminium toxicity occurred in two infants with congenital uraemia who had never received phosphate binders or other aluminium-containing agents or intravenous fluids. One patient was treated by peritoneal dialysis from the age of two weeks and died at three months after the sudden onset of neurological symptoms; the other died after one month of conservative management without dialysis. Brain aluminium concentration was high in both infants (6.4 and 47 micrograms/g, respectively) whereas bone aluminium content was normal and there were no histological changes or stainable aluminium on bone biopsy specimens. Both infants were fed with 'Similac PM 60/40'. To investigate possible sources of aluminium, powdered milk formula, sterilised water used for preparation of the feed, and dialysate concentrate (first patient) were analysed. Aluminium concentration was high (232 +/- 60 ng/ml) in powdered milk but negligible in sterilised water and dialysate concentrate (4 ng/ml and 3.4 +/- 2.4 ng/ml, respectively). These findings indicate that proprietary infant milk formula is another source of aluminium. Aluminium-free milk should contribute to the prevention of aluminium toxicity in infants with renal failure.