Aluminium exposure from parenteral nutrition in preterm infants and later health outcomes during childhood and adolescence

• Published in: Proceedings of the Nutrition Society 2011-08, Vol.70 (3), p.299-304
• Main Authors: Fewtrell, Mary S., Edmonds, Caroline J., Isaacs, Elizabeth, Bishop, Nick J., Lucas, Alan
• Format: Article
• Language: English
• Subjects: adolescence; Adolescent; Aluminum; Aluminum - metabolism; Aluminum - toxicity; anemia; Autopsies; Biopsy; blood serum; bone density; Bone Density - drug effects; Calcium; childhood; children; Cognitive ability; containers; Dementia; Dementia disorders; Double-Blind Method; Electrolytes; Environmental Monitoring; Follow-Up Studies; Food and Drug Administration; Food Contamination; gastrointestinal system; glass; Growth - drug effects; health services; Hemodialysis; Humans; Infant; Infant, Newborn; Infant, Premature - growth & development; Infants; intravenous injection; Intravenous therapy; lumbar spine; Nervous System - drug effects; Nervous System - growth & development; Nervous System Diseases - chemically induced; neurodevelopment; Newborn babies; Nutrition; parenteral feeding; Parenteral nutrition; Parenteral Nutrition - adverse effects; Parenteral Nutrition Solutions - adverse effects; Parenteral Nutrition Solutions - chemistry; patients; Potassium; Premature babies; Renal function; Spine; Symposium 2: Micronutrients under the microscope; toxicity; urine
• ISSN: 0029-6651; 1475-2719
• DOI: 10.1017/S0029665111000498

Aluminium is the most common metallic element, but has no known biological role. It accumulates in the body when protective gastrointestinal mechanisms are bypassed, renal function is impaired, or exposure is high – all of which apply frequently to preterm infants. Recognised clinical manifestations of aluminium toxicity include dementia, anaemia and bone disease. Parenteral nutrition (PN) solutions are liable to contamination with aluminium, particularly from acidic solutions in glass vials, notably calcium gluconate. When fed parenterally, infants retain >75% of the aluminium, with high serum, urine and tissue levels. Later health effects of neonatal intravenous aluminium exposure were investigated in a randomised trial comparing standard PN solutions with solutions specially sourced for low aluminium content. Preterm infants exposed for >10 d to standard solutions had impaired neurologic development at 18 months. At 13–15 years, subjects randomised to standard PN had lower lumbar spine bone mass; and, in non-randomised analyses, those with neonatal aluminium intake above the median had lower hip bone mass. Given the sizeable number of infants undergoing intensive care and still exposed to aluminium via PN, these findings have contemporary relevance. Until recently, little progress had been made on reducing aluminium exposure, and meeting Food and Drug Administration recommendations (