Aluminum neurotoxicity in preterm infants receiving intravenous-feeding solutions

N Engl J Med. 1997 May 29;336(22):1557-61. doi: 10.1056/NEJM199705293362203.


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=0.02). 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.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aluminum / adverse effects*
  • Child Development / drug effects*
  • Cognition Disorders / chemically induced
  • Cognition Disorders / complications
  • Dose-Response Relationship, Drug
  • Humans
  • Infant Food / adverse effects*
  • Infant, Newborn
  • Infant, Premature*
  • Intelligence / drug effects*
  • Intelligence Tests
  • Neuromuscular Diseases / complications
  • Parenteral Nutrition*
  • Prospective Studies


  • Aluminum