Chromium-free parenteral nutrition and its effects on chromium levels in very low birth weight infants.

Abstract

Background: as chromium (Cr) is known to contaminate components of parenteral nutrition (PN), Cr-free PN is recommended for preterm infants. Exposure to Cr by PN in preterm infants is scarcely investigated.

Objective: to describe Cr levels in plasma (Crp) and urine (Cru) during the first month of life in premature newborns ≤ 1500 g of birthweight (BW) receiving PN, and to evaluate the impact on postnatal clinical parameters.

Methods: a prospective observational study. Cr-free PN was administered at day 1 of life and continued until full enteral feeding with fortified breastmilk began. Crp levels at day 15 and 30 and Cru at day 30 of life were assessed according to demographic factors, biochemical markers and postnatal morbidity.

Results: 97 infants had a median gestational age (GA) of 29.9 weeks, and a median BW of 1205 g. Median Crp remained at 1.0 µg/L at 15 and 30 days (IQR 0.7-1.4 and 0.7-1.3, respectively). Premature babies < 26 weeks had a significantly higher Crp at one month than the remainder (p = 0.043) and higher Cr elimination in the urine (p = 0.026). Crp increased with prolonged PN (p < 0.001), even after adjusting for gestational age (p = 0.001). Laboratory parameters were not influenced by Crp or Cru, nor was morbidity.

Conclusion: Crp increases with days of PN even when a trace mineral supplement without Cr is used, and the level reached persists during the first month of life with the introduction of Cr-supplemented breastmilk feeding. No relation to morbidity was observed.