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Aluminum Toxicities from TPN
Fewtrell MS, Bishop NJ, MDb, Edmonds CJ, et al. Aluminum Exposure From Parenteral Nutrition in Preterm Infants: Bone Health at 15-Year Follow-up. PEDIATRICS (Nov 2009); 124 :1372-1379. [Full text] [PDF]
OBJECTIVE:
Aluminum has known neurotoxicity and may impair short-term bone
health. In a randomized trial, we showed reduced neurodevelopmental
scores in preterm infants who were previously exposed to aluminum
from parenteral nutrition solutions. Here, in the same cohort, we
test the hypothesis that neonatal aluminum exposure also adversely
affects long-term bone health, as indicated by reduced bone mass
.
METHODS: Bone area (BA) and bone mineral content (BMC) of lumbar
spine, hip, and whole body were measured with dual radiograph
absorptiometry in 13- to 15-year-olds who were born preterm and
randomly assigned standard or aluminum-depleted parenteral nutrition
solutions during the neonatal period.
RESULTS: Fifty-nine children (32% of survivors) were followed.
Those who were randomly assigned to standard parenteral nutrition
solution had lower lumbar spine BMC, apparently explained by a
concomitant decrease in bone size. In nonrandomized analyses,
children who were exposed to neonatal aluminum intakes above the
median (55 µg/kg) had lower hip BMC (by 7.6% [95% confidence interval
0.21–13.8]; P = 0.02), independent of bone (or body) size.
CONCLUSIONS: Neonates who are exposed to parenteral aluminum
may have reduced lumbar spine and hip bone mass during adolescence,
potential risk factors for later osteoporosis and hip fracture. These
findings need confirmation in larger, more detailed studies.
Nevertheless, given our previous finding of adverse developmental
outcome in these individuals and the sizeable number of contemporary
infants who undergo intensive neonatal care and are still exposed to
aluminum via parenteral feeding solutions, the potential adverse
long-term consequences of early aluminum exposure now deserve renewed
attention.
Comments. Parenteral nutrition solutions used in infants are contaminated with aluminum. The major source of this contamination is from the calcium gluconate solution. This results in premature infants receiving parenteral aluminum at a dose 6-12X higher than the limits recommended by the FDA. Aluminum is a known neurotoxin, and a previous study has demonstrated impaired neurologic development at 18 months of age in premature infants from this exposure. The present study suggests that this aluminum exposure in premature infants may also adversely effect their bone development. It’s time to replace the calcium gluconate in our TPN solutions with calcium chloride. This simple change would go a long way toward reducing aluminum toxicity. ABK
Date: 15 Dec 2009
Time: 18:08:55
BMC(Bone Mineral Content) in Premature infants has been dependent on Calcium and Phosphorus Ratios provided in TPN. Bone mineralization and growth are enhanced in preterm infants fed an isocaloric, nutrient-enriched preterm formula through term (www.ajcn.org/cgi/content/full/80/6/1595). Did the authors take these confounding variables into account, when extrapolating Aluminum Toxicity to reduced BMC at 13-14 years of age??
UserName: Ravi Agarwal
Institution: Fort Walton Beach Medical Center
telephone: 8504960855
email:
neodoc1@yahoo.com
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