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Unintentional Manganese Delivery in Neonatal Parenteral Nutrition

Jason B Sauberan1, Anup C Katheria

  • 1Neonatal Research Institute, Sharp Mary Birch Hospital for Women and Newborns, San Diego, CA.

Journal of Pediatric Gastroenterology and Nutrition
|April 9, 2020
PubMed

Insights

Neonatal parenteral nutrition (PN) contains significant manganese (Mn) from unintended sources, posing a neurotoxicity risk. Further research is needed to identify these sources and explore Mn omission strategies.

Area of Science:

  • Pediatric Nutrition
  • Neurotoxicology
  • Trace Element Analysis

Background:

  • Iatrogenic manganese (Mn) neurotoxicity is a significant safety concern for neonates receiving parenteral nutrition (PN).
  • Previous research indicates that contamination of PN ingredients may be an unintentional source of Mn delivery.
  • Understanding the contribution of unsourced Mn is crucial for mitigating risks in neonatal care.

Purpose of the Study:

  • To quantify the concentration of manganese (Mn) in neonatal PN solutions.
  • To determine the relative contribution of unsourced Mn to the total Mn exposure in neonatal PN.
  • To compare Mn levels in standard PN formulations versus those prepared without added Mn.

Main Methods:

  • Inductively coupled plasma mass spectrometry (ICP-MS) was used to measure Mn concentrations.
  • Neonatal PN solutions were prepared using a standard fixed-dose multiple trace element product.
  • Test solutions were prepared using individual trace element ingredients, excluding Mn, for comparison.

Main Results:

  • Standard PN solutions (n=6) exhibited a mean Mn concentration of 56.63 μg/L (SD 0.94).
  • Test solutions prepared without added Mn (n=6) showed significantly lower Mn levels, with a mean of 6.04 μg/L (SD 0.39).
  • These findings indicate substantial Mn presence in neonatal PN not intentionally added during preparation.

Conclusions:

  • Neonatal PN contains significant amounts of manganese from sources other than intentional addition.
  • Further investigation is required to pinpoint the specific ingredient sources of this unintentional Mn.
  • The feasibility of implementing Mn omission strategies in neonatal PN requires further study.

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