Aluminum neurotoxicity in preterm infants receiving intravenous-feeding solutions
Aluminum neurotoxicity in preterm infants receiving intravenous-feeding solutions
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DOI：
10.1056/nejm199705293362203
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发表时间：
1997-05-29
影响因子：
158.5
通讯作者：
Lucas, A
中科院分区：
文献类型：
--
作者：
Bishop, NJ;Morley, R;Lucas, A
背景铝是一种商业静脉营养液的污染物，具有潜在的神经毒性。我们调查了围产期暴露于静脉注射铝对早产儿神经发育的影响。方法我们随机分配了227名早产儿，胎龄小于34周，出生体重小于1850克，需要静脉喂养，然后才能开始肠内喂养，接受标准或特殊构成的，铝耗尽静脉喂养解决方案。结果90名接受标准喂养溶液的婴儿的平均（+/- SD）Bayley智力发育指数为95 +/- 22，相比之下，92名接受贫铝溶液的婴儿为98 +/- 20（P=0.39）。在对静脉喂养持续时间超过中位数且无神经运动损伤的婴儿进行的计划亚组分析中，39名接受标准溶液的婴儿和41名接受铝耗尽溶液的婴儿的Bayley智力发育指数平均值分别为92 +/- 20和102 +/- 17（P=0.2）。前者更有可能（39%，而后者为17%; P=0.03）有一个心理发展指数低于85，增加了他们随后的教育问题的风险。对于所有157名婴儿没有神经运动障碍，铝暴露增加与智力发育指数（P=0.03）的减少，与调整损失的一个点，每天静脉喂养的婴儿接受标准solutions.Conclusions在早产儿，长期静脉喂养与含铝的解决方案与受损的神经发育。(C)1997年，马萨诸塞州医学会。
Background Aluminum, a contaminant of commercial intravenous-feeding solutions, is potentially neurotoxic. We investigated the effect of perinatal exposure to intravenous aluminum on the neurologic development of infants born prematurely.Methods We randomly assigned 227 premature infants with gestational ages of less than 34 weeks and birth weights of less than 1850 g who required intravenous feeding before they could begin enteral feeding to receive either standard or specially constituted, aluminum-depleted intravenous-feeding solutions. The neurologic development of the 182 surviving infants who could be tested was assessed by using the Bayley Scales of Infant Development at 18 months of age.Results The 90 infants who received the standard feeding solutions had a mean (+/- SD) Bayley Mental Development index of 95 +/- 22, as compared with 98 +/- 20 for the 92 infants who received the aluminum-depleted solutions (P=0.39). In a planned subgroup analysis of infants in whom the duration of intravenous feeding exceeded the median and who did not have neuromotor impairment, the mean values for the Bayley Mental Development Index for the 39 infants who received the standard solutions and the 41 infants who received the aluminum-depleted solutions were 92 +/- 20 and 102 +/- 17, respectively (P=0.2). The former were significantly more likely (39 percent, vs, 17 percent of the latter group; P=0.03) to have a Mental Development Index of less than 85, increasing their risk of subsequent educational problems. For all 157 infants without neuromotor impairment, increasing aluminum exposure was associated with a reduction in the Mental Development Index (P=0.03), with an adjusted loss of one point per day of intravenous feeding for infants receiving the standard solutions.Conclusions In preterm infants, prolonged intravenous feeding with solutions containing aluminum is associated with impaired neurologic development. (C) 1997, Massachusetts Medical Society.