Published online October 26, 2009
PEDIATRICS Vol. 124 No. 5 November 2009, pp. 1372-1379 (doi:10.1542/peds.2009-0783)

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services E-mail this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Request Permissions Citing Articles Citing Articles via CrossRef Google Scholar Articles by Fewtrell, M. S. Articles by Lucas, A. PubMed PubMed Citation Articles by Fewtrell, M. S. Articles by Lucas, A. Related Collections Therapeutics & Toxicology Social Bookmarking                         What's this?

ARTICLE

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

Mary S. Fewtrell, MD^a, Nick J. Bishop, MD^b, Caroline J. Edmonds, PhD^a, Elizabeth B. Isaacs, PhD^a, Alan Lucas, MD^a

^a Medical Research Council Childhood Nutrition Research Centre, University College London Institute of Child Health, London, United Kingdom
^b Academic Unit of Child Health, Sheffield Children's NHS Foundation Trust, Sheffield, United Kingdom

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.

---

Key Words: preterm infant • bone health • parenteral nutrition • aluminum

Abbreviations: PN—parenteral nutrition • DXA—dual-energy x-ray absorptiometry • BMC—bone mineral content • BA—bone area • BMD—bone mineral density • LS—lumbar spine • WB—whole body • BMAD—bone mineral apparent density • SDS—SD score

---

Accepted Jun 9, 2009.

CiteULike    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?