Aluminum Loading in Preterm Neonates Revisited

Preterm neonates receiving parenteral nutrition are at risk of aluminum (Al) overload because of the presence of Al as a contaminant in parenteral formulations. Despite US Food and Drug Administration regulation, commercial products continue to present Al contamination. To reassess Al exposure in the premature neonatal population, the present study evaluated the Al balance (intake vs urinary excretion) in a group of preterm neonates during the period in which they stayed in the intensive care unit (NICU) under total parenteral nutrition. For the 10 patients selected, daily infusion solutions (nutrition and medication) were collected and the level of Al contamination was measured. From the urine collected daily, an aliquot was taken for Al determination. Blood was also collected for Al determination on the first and last day in the NICU. The measurements were carried out by atomic absorption spectrometry. The difference between Al administered and excreted revealed that 56.2% ± 22.7% of the Al intake was not eliminated. The mean serum Al levels from the first to the last day decreased from 41.2 ± 23.3 to 23.5 ± 11.2 μg/L. The resulting mean Al daily intake of the 10 patients was 15.2 ± 8.0 μg · kg −1 · day −1 . Because Al intake was higher than that excreted and Al in serum decreased to practically half during the period in the NICU (±7.3 days), some amount of Al deposition occurred. Moreover, premature neonates were receiving, on average, 3 times the amount of 5 μg · kg −1 · day −1 , considered by the Food and Drug Administration as a safe limit.