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Published on: November 11, 2014
Sources of unintentional manganese delivery in neonatal parenteral nutrition
Jason Sauberan1, Misty Mercier2, Anup Katheria1
1Neonatal Research Institute, Sharp Mary Birch Hospital for Women & Newborns, San Diego, California, USA.
Background:
Manganese (Mn) neurotoxicity is a concern in neonates receiving parenteral nutrition (PN). Prior studies have identified Mn contamination of PN ingredients as a source of daily Mn exposure from PN. This study was conducted to determine which neonatal PN ingredients are sources of this unintentional Mn delivery.
Methods:
Mn concentration was measured in different lot numbers of individual PN ingredients using inductively coupled plasma-mass spectrometry. PN admixtures were then prepared using standard doses of the tested individual ingredients, and admixture Mn concentration was measured.
Results:
Magnesium sulfate and calcium gluconate are the major contributors to hidden unintentional Mn exposure in neonatal PN. Maximum measured Mn concentrations in these two ingredients were 443 and 46.8 mcg/L, respectively. Sodium phosphate and potassium phosphate were the next highest at 40 and 24 mcg/L, respectively. Other ingredients contained a trivial or no measurable quantity of Mn. PN admixture Mn content was 16%-30% higher than predicted values based on individual ingredient Mn content. If infused at 150 ml/kg/day, a standard neonatal PN admixture with no added Mn is capable of unintentionally delivering up to 0.9 mcg/kg/day Mn.
Conclusion:
Neonatal PN without any added Mn provides close to the American Society for Parenteral and Enteral Nutrition (ASPEN)-recommended Mn dosage of 1 mcg/kg/day. This supports the potential utility of a Mn-omission approach to trace element provision in neonatal PN. Further studies are needed to test such an approach and to evaluate the clinical significance of unintended Mn delivery in neonates receiving PN.
Insights
Magnesium sulfate and calcium gluconate are major sources of unintentional manganese (Mn) exposure in neonatal parenteral nutrition (PN). This hidden Mn delivery can approach recommended dosages, suggesting Mn omission may be viable.
Area of Science:
- Neonatal medicine
- Trace element analysis
- Nutritional biochemistry
Background:
- Manganese (Mn) neurotoxicity is a significant concern for neonates receiving parenteral nutrition (PN).
- Previous research identified PN ingredients as a source of daily Mn exposure.
- This study aimed to pinpoint specific neonatal PN ingredients contributing to unintentional Mn delivery.
Purpose of the Study:
- Identify the primary sources of unintentional manganese (Mn) delivery in neonatal parenteral nutrition (PN).
- Quantify Mn concentrations in common PN ingredients.
- Assess the contribution of these ingredients to the overall Mn load in neonatal PN admixtures.
Main Methods:
- Inductively coupled plasma-mass spectrometry (ICP-MS) was used to measure Mn concentration in individual PN ingredients.
- PN admixtures were prepared using standard doses of tested ingredients.
- Mn concentration in the final PN admixtures was measured to determine total Mn content.
Main Results:
- Magnesium sulfate and calcium gluconate were identified as the major contributors to unintentional Mn exposure.
- Maximum Mn concentrations detected were 443 mcg/L in magnesium sulfate and 46.8 mcg/L in calcium gluconate.
- PN admixtures showed 16%-30% higher Mn content than predicted, delivering up to 0.9 mcg/kg/day without added Mn.
Conclusions:
- Neonatal PN without added Mn provides Mn levels close to the ASPEN-recommended dosage.
- A Mn-omission approach for trace element provision in neonatal PN shows potential utility.
- Further research is required to validate the Mn-omission strategy and assess the clinical impact of unintended Mn delivery.
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