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Aluminum neurotoxicity in preterm infants receiving intravenous-feeding solutions
N J Bishop1, R Morley, J P Day
1Medical Research Council (MRC) Dunn Nutrition Unit, Cambridge, United Kingdom.
Insights
Perinatal exposure to aluminum in intravenous-feeding solutions may harm neurologic development in premature infants. Reducing aluminum exposure is crucial for better neurodevelopmental outcomes in vulnerable newborns.
Area of Science:
- Neonatalogy
- Neurodevelopmental Pediatrics
- Toxicology
Background:
- Aluminum is a contaminant in commercial intravenous-feeding solutions.
- Aluminum exposure is a potential neurotoxin.
- The impact of perinatal aluminum exposure on premature infants' neurologic development requires investigation.
Purpose of the Study:
- To investigate the effect of perinatal exposure to intravenous aluminum on the neurologic development of infants born prematurely.
- To assess if aluminum-depleted intravenous-feeding solutions improve neurodevelopmental outcomes in preterm infants.
Main Methods:
- A randomized controlled trial involving 227 premature infants (gestational age < 34 weeks, birth weight < 1850 g) requiring intravenous feeding.
- Infants received either standard or aluminum-depleted intravenous-feeding solutions.
- Neurologic development was assessed at 18 months using the Bayley Scales of Infant Development for 182 surviving infants.
Main Results:
- No significant difference in the mean Bayley Mental Development Index (MDI) between groups overall (95 vs. 98, P=0.39).
- In a subgroup of infants with prolonged intravenous feeding and no neuromotor impairment, those receiving standard solutions had lower mean MDI (92 vs. 102, P=0.02) and were more likely to have an MDI < 85 (39% vs. 17%, P=0.03).
- Increased aluminum exposure was associated with reduced MDI in infants without neuromotor impairment (P=0.03).
Conclusions:
- Prolonged intravenous feeding with aluminum-containing solutions is linked to impaired neurologic development in preterm infants.
- Reducing aluminum exposure in intravenous-feeding solutions may be beneficial for neurodevelopmental outcomes.
- Further research is warranted to confirm these findings and establish safe aluminum exposure limits.
Background:
Aluminum, a contaminant of commercial intravenous-feeding solutions, is potentially neurotoxic. We investigated the effect of perinatal exposure to intravenous aluminum on the neurologic development of infants born prematurely.
Methods:
We randomly assigned 227 premature infants with gestational ages of less than 34 weeks and birth weights of less than 1850 g who required intravenous feeding before they could begin enteral feeding to receive either standard or specially constituted, aluminum-depleted intravenous-feeding solutions. The neurologic development of the 182 surviving infants who could be tested was assessed by using the Bayley Scales of Infant Development at 18 months of age.
Results:
The 90 infants who received the standard feeding solutions had a mean (+/-SD) Bayley Mental Development Index of 95+/-22, as compared with 98+/-20 for the 92 infants who received the aluminum-depleted solutions (P=0.39). In a planned subgroup analysis of infants in whom the duration of intravenous feeding exceeded the median and who did not have neuromotor impairment, the mean values for the Bayley Mental Development Index for the 39 infants who received the standard solutions and the 41 infants who received the aluminum-depleted solutions were 92+/-20 and 102+/-17, respectively (P=0.02). The former were significantly more likely (39 percent, vs. 17 percent of the latter group; P=0.03) to have a Mental Development Index of less than 85, increasing their risk of subsequent educational problems. For all 157 infants without neuromotor impairment, increasing aluminum exposure was associated with a reduction in the Mental Development Index (P=0.03), with an adjusted loss of one point per day of intravenous feeding for infants receiving the standard solutions.
Conclusions:
In preterm infants, prolonged intravenous feeding with solutions containing aluminum is associated with impaired neurologic development.