Total Parenteral Nutrition and Red Blood Cell Transfusion Provide Exposure Route
Premature infants frequently stay in a neonatal intensive care unit (NICU) for specialized medical care. Total parenteral nutrition (TPN) and red blood cell (RBC) transfusions are two types of clinical management that premature infants encounter in the NICU. A recent study has assessed the exposure of premature infants to toxic metals during their stay in the NICU from TPN and RBC transfusions and the potential risk of neurodevelopmental delay at age 2 months. The research included 33 preterm infants that required TPN and RBC transfusions. Blood samples from the infants were collected for metal analysis at two different time points (admission and before discharge). Metals in the daily TPN were analyzed, and neurodevelopment was assessed using the Ages and Stages Questionnaire Edition 3 (ASQ-3). The authors discovered that all samples of TPN had metal contamination: 96% exceeded the critical arsenic limit (0.3 μg/kg body weight/day). They also found that the added daily manganese intake from TPN for preterm infants surpassed the recommended dose (1 µg/kg body weight), raising safety concerns. Additionally, the authors discovered that all samples of RBC transfusions exceeded the estimated intravenous reference dose for lead (0.19 µg/kg body weight). Levels of mercury, lead and manganese in preterm infants at discharge decreased 0.867 µg/L (95% CI, 0.76, 0.988), 0.831 (95%CI, 0.779, 0.886) and 0.847 µg/L (95% CI, 0.775, 0.926), respectively. The researchers identified a decrease in ASQ-3-problem solving scores associated with higher levels of blood lead in preterm infants taken at admission (ß = −0.405, 95%CI = −0.655, −0.014) and with plasma manganese (ß = −0.562, 95%CI = −0.995, −0.172). They also observed an association between decreased personal social domain scores with higher blood lead levels of preterm infants before discharge (ß = −0.537, 95%CI = −0.905, −0.045). The authors suggest that their findings provide evidence that TPN intake and RBC transfusions may expose preterm infants to certain toxic metals that could harm neurodevelopment at 2 months of age. However, since some metals were found in preterm infants’ blood samples at admission, they believe that in utero metal exposure is also an issue.
