Aluminum Exposure From Parenteral Nutrition in Preterm Infants: Bone Health at 15-Year Follow-up

Abstract

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.

Parenteral aluminum induces liver injury in a newborn piglet model

“…However, there are no similar limits of aluminum contamination of small volume components such as calcium gluconate, which accounts for 85% of the aluminum contamination in infant PN therapy. Despite these recommendations, the level of aluminum contamination of infant PN therapy is reported to be 10-60 μg/kg per day [3][4][5][6]. Premature infants with immature kidneys and high aluminum exposure are particularly vulnerable to aluminum toxicity.…”

Effects of aluminum exposure on the allergic responses and humoral immune function in rats

“…The residual of available aluminum (Al) in biologically ecosystem has been substantially increasing during recent years, so Al contamination becomes an increasing problem in human society (Hewitt et al 1990;Rengel 2004;Fewtrell et al 2009). It was reported that Al exposure caused delayed hypersensitivity.…”

Does early nutrition program later bone health in preterm infants?

“…In a randomized trial in preterm infants receiving either standard aluminum solutions or specially prepared low-aluminum parenteral nutrition solution, in which calcium gluconate was replaced by calcium chloride, we showed that infants fed the low-aluminum solution had significantly higher scores on the Bayley mental development index at 18 mo corrected age (14). More recently, at age 15 y, we reported higher lumbar spine BMD in these subjects (15). Furthermore, subjects exposed to aluminum concentrations above the median during the neonatal period had a significantly lower hip bone mineral content.…”