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首页> 外文期刊>Proceedings of the Nutrition Society >Aluminium exposure from parenteral nutrition in preterm infants and later health outcomes during childhood and adolescence
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Aluminium exposure from parenteral nutrition in preterm infants and later health outcomes during childhood and adolescence

机译：早产儿胃肠外营养中铝的暴露以及儿童和青春期以后的健康状况

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摘要

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 mu g/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.
机译：铝是最常见的金属元素，但没有已知的生物学作用。当绕过保护性胃肠道机制，肾功能受损或暴露量很高时，它会在体内积聚，所有这些都经常应用于早产儿。铝毒性的公认临床表现包括痴呆，贫血和骨骼疾病。肠胃外营养（PN）溶液容易被铝污染，特别是玻璃小瓶中的酸性溶液，尤其是葡萄糖酸钙。肠胃外喂养时，婴儿的铝含量> 75％，血清，尿液和组织水平较高。在一项随机试验中研究了新生儿静脉铝暴露的后期健康影响，该试验将标准PN溶液与专门为低铝含量采购的溶液进行了比较。暴露于标准溶液中> 10 d的早产儿在18个月时神经系统发育受损。在13-15岁时，随机分配至标准PN的受试者的腰椎骨量较低;并且，在非随机分析中，新生儿铝摄入量高于中位数的人的髋骨质量较低。鉴于有大量婴儿正在接受重症监护，并且仍通过PN暴露于铝中，因此这些发现具有当代意义。直到最近，在减少铝暴露方面进展甚微，并且使用现有产品，要达到食品和药物管理局的建议（<5μg/ kg /天，对于<50kg的患者）是不可能的。英国药品和医疗保健监管局最近的建议是，对于小于18岁的儿童，不应将小容量玻璃容器中的葡萄糖酸钙用于重复治疗，包括PN的制备，是解决此问题的重要步骤。

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