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Aluminum in the neonate related to parenteral nutrition
A Moreno1, C Domínguez, A Ballabriga
1Paediatric Intensive Care Unit, Children's Hospital Vall d'Hebron, Autonomous University of Barcelona, Spain.
Insights
Parenteral nutrition is the primary source of aluminum exposure in newborns. Both preterm and full-term infants accumulate aluminum in tissues, with elevated levels persisting after nutrition therapy cessation.
Area of Science:
- Neonatal Medicine
- Toxicology
- Biochemistry
Background:
- Parenteral nutrition (PN) is crucial for neonatal care but may introduce aluminum.
- Understanding aluminum exposure sources and accumulation is vital for infant health.
Purpose of the Study:
- To investigate aluminum loading and exposure sources in preterm and full-term neonates.
- To assess aluminum levels during and after parenteral nutrition.
Main Methods:
- Studied aluminum intake from PN solutions in 35 neonates (26 preterm, 9 term).
- Monitored blood and urine aluminum levels over 28 days and urine levels up to 13 weeks.
- Analyzed post-mortem tissue samples for aluminum content.
Main Results:
- Parenteral nutrition solutions accounted for 88.7% of total aluminum intake.
- Significantly elevated serum and urine aluminum levels were observed during PN (p < 0.001).
- High urine aluminum/creatinine ratios persisted for up to 10 weeks post-PN, indicating tissue loading.
Conclusions:
- Neonates, both preterm and full-term, are susceptible to aluminum accumulation from PN.
- Elevated aluminum levels suggest potential long-term tissue burden.
- Further research into safe aluminum limits in neonatal PN is warranted.
Abstract:
Sources of aluminium loading and exposure in preterm and full-term newborns were studied. Parenteral nutrition solutions were the main source of aluminium representing 88.7% of total aluminium intake. Blood and urine aluminium levels were followed over a 28-day period in a group of 26 preterm and 9 term infants while receiving parenteral nutrition (duration 15.6 +/- 8.7 days) and later when being formula fed. Urine levels were followed up to 13 weeks in a subgroup of the neonates. Serum aluminium levels (0.86 +/- 0.38 mumol/l) and urine aluminium/creatinine ratio (1.52 +/- 0.81 mumol/mmol) were increased when the infants were receiving parenteral nutrition compared with the control group (p < 0.001). The urine aluminium/creatinine ratio remained high up to 10 weeks following withdrawal of parenteral nutrition and suggested tissular loading. This was confirmed after high aluminium levels were found in post-mortem brain and bone samples from two preterm and one full-term infant. We conclude that both preterm and full-term neonates are susceptible to accumulation of aluminium in tissue while receiving parenteral nutrition.