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Unexpected Serum and Urine Aluminum Concentrations in Pediatric Patients on Home Parenteral Nutrition

Hanna Romanowska1, Klaudia Bartoszewicz1, Mikołaj Danko2

  • 1Department of Pediatrics, Endocrinology, Diabetology, Metabolic Diseases and Cardiology of the Developmental Age, Pomeranian Medical University, Unii Lubelskiej 1, 71-252 Szczecin, Poland.

Nutrients
|August 26, 2023
PubMed

Insights

Long-term parenteral nutrition (PN) in children leads to high aluminum (Al) levels, increasing health risks. Environmental factors also influence aluminum concentrations in healthy children.

Area of Science:

  • Pediatric Nephrology
  • Clinical Nutrition
  • Toxicology

Background:

  • Intravenous aluminum (Al) from parenteral nutrition (PN) poses significant health risks, including metabolic bone disease, anemia, and neurological complications in children.
  • Assessing aluminum accumulation and excretion is crucial for managing long-term PN therapy in pediatric patients.

Purpose of the Study:

  • To evaluate the impact of long-term home parenteral nutrition (HPN) on serum aluminum concentrations and urinary aluminum excretion in children.
  • To compare aluminum levels in children receiving HPN with those of healthy children.

Main Methods:

  • Serum and urinary aluminum concentrations were measured in 83 children enrolled in the Polish HPN program (2004-2022).
  • A control group of 121 healthy children was included for comparison.
  • Analysis differentiated between HPN initiated in the neonatal period versus later in childhood.

Main Results:

  • Children with HPN initiated in the neonatal period exhibited higher serum and urinary aluminum levels compared to those starting HPN later.
  • A significant majority (88%) of children on chronic HPN had serum aluminum concentrations exceeding 5 μg/L.
  • Surprisingly, healthy children displayed higher serum aluminum levels than the HPN group, suggesting environmental and dietary influences.

Conclusions:

  • Long-term parenteral nutrition, especially when initiated neonatally, significantly elevates aluminum body burden in children.
  • Current PN practices may not adequately mitigate aluminum exposure risks.
  • Environmental and dietary aluminum exposure warrants further investigation in pediatric populations.

Keywords:
aluminumblood serumchildrennewbornsparenteral nutritionurine

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