Impact of plasma aluminum on neurocognitive outcomes at early school age in children with intestinal failure.

Abstract

Background: Aluminum (AL) is a known contaminant in parenteral nutrition (PN) and is associated with bone disease, and neurotoxicity. We aimed to evaluate the association between plasma AL concentration and neurocognitive outcomes at early school age, in children with intestinal failure (IF) receiving long-term PN.

Methods: This retrospective cohort study included children diagnosed with IF before 2 years of age, with at least one measurement of plasma AL who completed a neuropsychological assessment between 4 and 8 years. Spearman correlation coefficient was used to explore the association between AL concentrations and neurocognitive scores.

Results: Nineteen patients (12 males, median gestational age of 35 weeks) were included. The median number of PN years was 9.5 (IQR 7.4-11.8). Median and peak AL concentrations were 363 nmol/L (IQR 233-580) and 832 nmol/L (IQR 491.5-1361.5), respectively. Mean age at assessment was 6.32 + /-0.92 years. The mean full-scale intelligence quotient (FSIQ) was 95.8 + /-13.8. There was a moderate, inverse correlation between mean AL concentration before age three (- 0.56, p = 0.020) and FSIQ. For other domains, the strongest association was found between visual memory and the mean AL concentration before assessment (-0.67, p = 0.006).

Conclusions: Higher plasma AL concentrations in children at early school age with IF were modestly associated with lower IQ and visual memory scores. Plasma AL monitoring allows early detection of abnormal plasma concentration, minimization of AL in PN and potentially prevention of neurotoxicity in young children with IF.