Proceedings of the Nutrition Society

The Annual Meeting of the Nutrition Society and BAPEN, Harrogate International Centre, Harrogate.2–3 November 2010,

Conference on ‘Malnutrition matters’

Symposium 2: Micronutrients under the microscope

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

Mary S. Fewtrella1 c1, Caroline J. Edmondsa2, Elizabeth Isaacsa1, Nick J. Bishopa3 and Alan Lucasa1

a1 Childhood Nutrition Research Centre, UCL Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK

a2 School of Psychology, University of East London, Stratford Campus, Water Lane, London E15 4LZ, UK

a3 Academic Unit of Child Health, Sheffield Children's Hospital, Sheffield S10 2TH, UK

Abstract

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 (<5 μg/kg per d) has been impossible in patients <50 kg using available products. Recent advice from the UK Medicines and Healthcare regulatory Authority that calcium gluconate in small volume glass containers should not be used for repeated treatment in children <18 years, including preparation of PN, is an important step towards addressing this problem.

(Online publication June 10 2011)

Correspondence:

c1 Corresponding author: Dr Mary S. Fewtrell, fax +44 2078319903, email m.fewtrell@ich.ucl.ac.uk