Original Article
Aluminum Neurotoxicity in Preterm Infants Receiving Intravenous-Feeding Solutions
N Engl J Med 1997; 336:1557-1562May 29, 1997DOI: 10.1056/NEJM199705293362203
- Abstract
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.
Media in This Article
Table 1
Composition and Aluminum Content of the Standard and Aluminum-Depleted Intravenous Feeding Solutions.Table 2
Demographic Characteristics of the Preterm Infants in the Groups Receiving Standard and Aluminum-Depleted Feeding Solutions.Article Activity
- Article
Aluminum toxicity occurs in adults and children with renal insufficiency who are treated by dialysis with aluminum-contaminated solutions or oral phosphate-binding agents that contain aluminum.1-7 The clinical manifestations of aluminum toxicity include hypochromic, microcytic anemia; bone disease3,5,8-10; and progressive dementia with increased concentrations of aluminum in the brain.7,11,12
Aluminum accumulates in the body when protective gastrointestinal mechanisms are bypassed, renal function is impaired, and exposure is high. These conditions are met in intravenously fed preterm infants, whose renal function is frequently compromised during their initial course; some have had high plasma aluminum concentrations.13-17 We previously reported on a preterm infant who died unexpectedly and whose brain aluminum concentration was similar to that of adults who died with aluminum intoxication.18
We hypothesized that increased aluminum exposure in this vulnerable population would probably have detrimental effects on neurologic development in the long term. We undertook this prospective study in preterm infants to compare the effect on the infants' subsequent neurologic development of standard intravenous-feeding solutions, similar to those used in routine practice in the United States and Europe, and solutions whose aluminum content had been reduced.
Methods
Subjects
We enrolled 227 infants from the neonatal intensive care unit of Rosie Maternity Hospital, in Cambridge, United Kingdom, from May 1988 to January 1991. The criteria for entry into the study were a clinical decision to initiate intravenous feeding, a birth weight of less than 1850 g, and a gestational age of less than 34 weeks. Infants whose mothers were not residents of the United Kingdom and infants with major congenital malformations were excluded from the study.
Each infant entering the study was randomly assigned by the pharmacy according to a multiple permuted-block method to receive either the standard or the aluminum-depleted intravenous solutions. Investigators and attending staff were unaware of the assignments, and no investigator served as an attending physician. The study was approved by the relevant ethics committees, and parental consent was obtained for each infant.
Feeding Policy
Intravenous feeding was introduced (typically on postnatal day 2 or 3) and stopped at the discretion of members of the senior attending clinical staff. The proportion by volume of amino acid solution (Vamin Infant, Kabi Vitrum, now Pharmacia, Stockholm, Sweden) was increased at one- or two-day intervals from 15 percent to 30 percent in increments of 5 percent. Intravenous fat intake (Intralipid 20 percent, Kabi Vitrum) was increased from 0.5 g per kilogram of body weight per day to 3 g per kilogram per day as the infant's clinical condition allowed. The volumes of calcium and phosphate solution administered depended on the amino acid concentration of the feeding solution. For solutions that contained 15 or 20 percent amino acids by volume, the calcium and phosphate contents were 36 and 18 mg per deciliter, respectively. For solutions that contained 25 or 30 percent amino acids by volume, the calcium and phosphate contents were 44 and 25 mg per deciliter, respectively.
In 19 infants, the decision to initiate intravenous feeding was reversed immediately after randomization on clinical grounds (typically, metabolic instability or improvement eliminating the need for parenteral feeding), and therefore none was given. These infants remained in the study and their results at the follow-up examination are included in the appropriate groups.
Enteral feeding was increased gradually to 180 ml per kilogram every 24 hours, according to tolerance. Mothers were encouraged to provide breast milk. If the mother provided no breast milk or an insufficient amount, a standard preterm formula was used (Farley's Health Products, Kendal, United Kingdom).
Intravenous Solutions
The compositions of the two types of solution were identical except that the aluminum-depleted solutions contained less aluminum and more chloride, reflecting the use of calcium chloride instead of calcium gluconate (Table 1Table 1
Composition and Aluminum Content of the Standard and Aluminum-Depleted Intravenous Feeding Solutions.). The use of a mixed sodium–potassium phosphate solution in place of potassium acid phosphate minimized this increase in chloride.Data Collection
We collected data on the neonatal course of each infant, including data on intravenous fluid intake and the total volume and type of fluid given. Plasma concentrations of sodium, potassium, urea, creatinine, glucose, and calcium and acid–base status were measured daily, and plasma chloride weekly. Cranial ultrasonography was performed weekly. Extensive social, demographic, and obstetrical data were collected from the mothers by trained research nurses unaware of treatment-group assignments. Social class was coded according to the British Registrar General's Classification of Occupations, on the basis of the occupation of the income-providing parent or the father's occupation if both parents were earning. The mother's education was coded according to her formal educational attainment (1 for mothers with no certificates to 5 for those with a university degree or similar educational level).
Neurodevelopmental Assessments
All the surviving children were invited to have a follow-up examination at the post-term age of 18 months. The examination consisted of a standard neurologic assessment19 and an evaluation of development by a single experienced investigator unaware of the children's group assignments, using the Mental Scale of the Bayley Scales of Infant Development,20 from which the Mental Development Index was derived (mean [±SD] for normal children, 100±16; possible range, 50 to 150).
A diagnosis of neuromotor impairment was made if the physical examination revealed abnormalities of tone or of the movement of limbs, trunk, head, or neck. The reference ranges used were from the schema of Amiel-Tison and Stewart.19 Since any degree of impairment can influence the assessment of development with the Bayley Mental Scale (which depends heavily on age-appropriate fine-motor skills), the severity of the impairment was not taken into account in the analyses.
Measurement of Aluminum
The aluminum content of the intravenous-feeding solutions was measured by graphite-furnace atomic-absorption spectrometry, with the use of Zeeman-effect background correction (model Z3030, Perkin Elmer, Beaconsfield, United Kingdom). Analyte materials were diluted appropriately (with a minimum of a fourfold dilution) with 0.1 percent Triton X-100 and 0.1 M nitric acid (BDH AnalaR and Aristar grade, respectively) and calibrated by using a standard solution of aluminum (1 mg per liter) in 0.1 M nitric acid (coefficient of variation, 6 to 8 percent). All measurements were performed in quadruplicate.21 Multiple batches of calcium gluconate (from four manufacturers) and calcium chloride (two manufacturers) were analyzed; concentrations of aluminum were consistently high for gluconate (4810±440 μg per liter) and low for chloride (210±10 μg per liter). All other components were analyzed on multiple occasions; the values shown in Table 1 are the mean values. Aluminum intake (component volume times component aluminum concentration) was calculated daily for each infant.
Statistical Analysis
Our primary hypothesis was that neurologic development would be better in infants receiving the aluminum-depleted solutions. However, two factors were likely to confound the analysis: the difficulty of accurately assessing mental development in children with neuromotor impairment and the variation in the duration of intravenous feeding and hence in aluminum intake.
The Bayley Mental Scale, like most tests of mental ability in young children, requires age-appropriate fine-motor skills; therefore, scores do not usually reflect the level of intellectual ability of children with neuromotor impairment. For this reason, the main analyses were performed as reported previously22 and as planned here by using Student's t-test, excluding the 25 children with evidence of neuromotor impairment at the time of testing. However, data on these infants were included in a separate analysis, in which children with neuromotor impairment arbitrarily received a score of 50 points and the data were analyzed as randomized by the Mann–Whitney–Wilcoxon test. Two infants could not be tested, because one was blind and the other completely uncooperative.
We also planned stratified analyses to take into account the duration of aluminum exposure — since once randomized, some infants would receive little intravenous feeding — and to seek threshold effects. The simplest stratification envisaged was to subdivide each group into two according to the duration of parenteral feeding (longer or shorter than the overall median), necessarily decreasing group numbers but maintaining similar numbers in each group. The effect of other variables known to influence developmental outcome was evaluated by multiple regression analysis.
Results
The characteristics of the infants in each group are shown in Table 2Table 2
Demographic Characteristics of the Preterm Infants in the Groups Receiving Standard and Aluminum-Depleted Feeding Solutions.; daily aluminum intake was substantially greater in the infants receiving the standard solutions than in those receiving the aluminum-depleted solutions (mean [±SD], 19±8 vs. 3±1 μg per kilogram per day; P<0.001). The numbers of deaths, handicapped survivors, and children lost to follow-up are shown in Table 3Table 3
Numbers of Infants in the Groups Receiving the Standard and Aluminum-Depleted Feeding Solutions at Study Entry and at the Time of Testing for the Bayley Mental Development Index..Among the infants with no neuromotor impairment, the mean (±SD) Mental Development Index values for the groups receiving the standard and aluminum-depleted solutions were 98±20 and 101±18, respectively (Table 4Table 4
Values on the Bayley Mental Development Index for Infants without Neuromotor Impairment and for All Infants According to the Duration of Intravenous Feeding.). The Mental Development Index values for all the groups of infants who received intravenous feeding for 10 days (median duration of exposure) or less were similar. However, for the group of infants receiving the standard solutions for more than 10 days, the Mental Development Index was 10 points less than for those receiving the aluminum-depleted solutions (P = 0.02). This difference was reflected in the significantly greater proportion of infants who received the standard solutions for more than 10 days and whose Mental Development Index values were below 85 points — 15 of 39 (38 percent) as compared with 7 of 41 (17 percent, P = 0.03).The corresponding analyses, including the children with neuromotor impairment, are also shown in Table 4. The results are weakened by the difficulty of obtaining realistic measurements of mental development in children with neuromotor impairment. Such children were thus given nominal scores of 50 points. When the results for the infants receiving intravenous feeding for more than 10 days were then compared by a nonparametric Mann–Whitney–Wilcoxon test, the difference between the groups was statistically significant (P = 0.04).
In a further, explanatory analysis to assess the independent contribution of aluminum intake to the developmental outcome, multiple regression analysis with the Bayley Mental Development Index as the dependent variable was carried out for the group of 157 infants with no evidence of neuromotor impairment at 18 months of age. The independent variables entered were birth weight, gestational age, sex, maternal educational attainment, social class, duration of intravenous feeding (days), duration of ventilation (days), aluminum intake (micrograms per kilogram), and the presence or absence of intraventricular hemorrhage (and whether parenchymal or not). The variables not significantly associated with the Mental Development Index in the model were removed stepwise. The duration of intravenous feeding was entered into the final analysis so that aluminum exposure did not become a proxy for the duration or severity of illness. Maternal educational attainment (P<0.001), birth weight (P = 0.01), aluminum exposure (P = 0.02), and sex (advantage for female sex, P = 0.02) were the factors that, in combination, most strongly predicted the Bayley Mental Development Index. There was no interaction between aluminum intake and the other factors. Thus, the apparent effect of aluminum was unrelated to birth weight or sex; that is, for a given level of intake, the effect on the Mental Development Index was the same in large and small infants. Gestational age, duration of ventilation, and the presence or absence of intraventricular hemorrhage were not significantly associated with the Mental Development Index.
We estimate that for infants receiving full intravenous feeding with a mean aluminum intake of 45 μg per kilogram per day, the expected reduction in the Bayley Mental Development Index would be, on average, one point per day of intravenous feeding.
There was no significant difference in clinical course or plasma biochemical results between the two groups. Despite the increased chloride load attendant on the use of the aluminum-depleted solutions, there were no episodes of hyperchloremia among infants receiving these solutions. There was no difference in the number of episodes of extravasation resulting in cutaneous damage between the two groups. No infant required flushing of, or surgery on, an extravasation site.
Discussion
The results of this study suggest that aluminum intake in preterm infants is associated with reduced developmental attainment at the corrected post-term age of 18 months. The infants who received the standard intravenous feeding solutions (providing 25 μg of aluminum per deciliter) had a lower mean Bayley Mental Development Index than those who received aluminum-depleted solutions (providing 2.2 μg of aluminum per deciliter), although this difference did not reach statistical significance. However, a substantial number of infants received little or no intravenous feeding after randomization, and explanatory analysis showed that the effect of aluminum exposure was dose-related. Aluminum exposure from the standard intravenous solutions was calculated to be associated with a mean loss of one point on the Bayley Mental Development Index per day of full intravenous feeding, after adjustment for potentially confounding factors. In infants fed intravenously for 10 or more days, those receiving the standard solutions had a major (10 point) deficit in their Mental Development Index and were twice as likely to have a Mental Development Index below 85. These results provide support for our hypothesis that intravenous aluminum may have neurotoxic effects, with longer-term consequences for neurologic development.
Aluminum is the most common metallic element in the earth's crust23 but has no clear biologic role. When intake is not controlled, aluminum causes severe neurotoxic effects in adults and children with renal failure.6,7,11,12 Previous studies of aluminum exposure in preterm infants revealed increased plasma concentrations or urinary excretion of aluminum, and those who died had high tissue aluminum concentrations.13-18,24-26 Our findings are therefore plausible in the light of the previous work on aluminum neurotoxicity and on the deposition of aluminum in tissues, including the brain, of preterm infants.
We chose to carry out a randomized study because in a nonrandomized study it would have been difficult to identify any effects of aluminum among the many other factors that could influence neurologic development in preterm infants. Indeed, manifestations of aluminum toxicity — anemia and bone disease — arise frequently in premature infants for reasons other than aluminum exposure. In our previous studies of preterm infants we found that by 18 months of age, cognitive performance on the Bayley Mental Development Index has some value in predicting the later intelligence quotient. However, the correlation is considerably greater for group mean scores than for individual infants (>0.9 rather than >0.5, unpublished data). Whether exposure to aluminum affects intelligence later in life is unknown.
In conclusion, aluminum has no known biologic role and is potentially neurotoxic. Some degree of aluminum exposure in preterm infants fed intravenously seems unavoidable; the duration of such exposure is necessarily uncertain. Our findings suggest that the use of aluminum-depleted solutions for intravenous feeding in these infants may result in improved neurologic development.
Supported by the United Kingdom Medical Research Council and the Wellcome Trust.
We are indebted to the nurses and doctors of the Rosie Maternity Hospital neonatal intensive care unit; to Ms. Sarah Churchill, Ms. Penny Lucas, and Ms. Corina Adams for data collection; and to the pharmacy staff, particularly Ms. Naval Vyse.
Source Information
From the Medical Research Council (MRC) Dunn Nutrition Unit and University of Cambridge Department of Paediatrics, Cambridge (N.J.B.); the MRC Childhood Nutrition Research Centre, Institute of Child Health, London (R.M., A.L.); and the University of Manchester Department of Chemistry, Manchester (J.P.D.) — all in the United Kingdom.
Address reprint requests to Dr. Bishop at the Genetics Unit, Shriners' Hospital for Crippled Children, 1529 Cedar Ave., Montreal, QC H3G 1A6, Canada.
- References
References
1
Bettinelli A Buratti M Elicio T Colombi A Aghemio A Edefonti A
Web of Science | Medline2
American Academy of Pediatrics Committee on Nutrition
Web of Science | Medline3
Faugere MC, Arnala IO, Ritz E, Malluche HH. Loss of bone resulting from accumulation of aluminum in bone of patients undergoing dialysis.J Lab Clin Med 1986;107:481-7.
4
Gruskin AB
Medline5
Koo WW Kaplan LA
Web of Science | Medline6
Nathan E Pedersen SE
CrossRef | Web of Science | Medline7
O'Hare JA Callaghan NM Murnaghan DJ
CrossRef | Web of Science | Medline8
Boyce BF Fell GS Elder HY
CrossRef | Web of Science | Medline9
Salusky IB Goodman WG
Medline10
Ward MK Feest TG Ellis HA Parkinson IS Kerr DN
CrossRef | Web of Science | Medline11
Sedman AB Wilkening GN Warady BA Lum GM Alfrey AC
CrossRef | Web of Science | Medline12
Alfrey AC LeGendre GR Kaehny WD
Full Text | Web of Science | Medline13
Bougle D Bureau F Voirin J Neuville D Duhamel JF
CrossRef | Web of Science | Medline14
Koo WW Kaplan LA Krug-Wispe SK Succop P Bendon R
CrossRef | Web of Science | Medline15
Koo WW Krug-Wispe SK Succop P Bendon R Kaplan LA
Web of Science | Medline16
Robinson MJ Ryan SW Newton CJ Day JP Hewitt CD O'Hara M
CrossRef | Web of Science | Medline17
Sedman AB Klein GL Merritt RJ
Full Text | Web of Science | Medline18
Bishop NJ Robinson MJ Lendon M Hewitt CD Day JP O'Hara M
CrossRef | Web of Science | Medline19
Amiel-Tison C Stewart A
CrossRef | Web of Science | Medline20
Bayley N. Bayley scales of infant development. New York: Psychological Corporation, 1969.
21
McGraw M Bishop N Jameson R
CrossRef | Web of Science | Medline22
Lucas A Morley R Cole TJ
CrossRef | Web of Science | Medline23
Wills MR Savory J
CrossRef | Web of Science | Medline24
Koo WW Kaplan LA Bendon R
CrossRef | Web of Science | Medline25
Moreno A Dominguez C Ballabriga A
CrossRef | Web of Science | Medline26
Puntis JW Hall K Booth IW
CrossRef | Web of Science | Medline
- Citing Articles (122)
Citing Articles
1
Keith Schofield. . (2017) The Metal Neurotoxins: An Important Role in Current Human Neural Epidemics?. International Journal of Environmental Research and Public Health 14:12, 1511.
CrossRef2
Megan Fortenberry, Lela Hernandez, Jacob Morton. . (2017) Evaluating Differences in Aluminum Exposure through Parenteral Nutrition in Neonatal Morbidities. Nutrients 9:11, 1249.
CrossRef3
Mateusz P. Karwowski, Catherine Stamoulis, Larissa M. Wenren, G. Mayowa Faboyede, Nicolle Quinn, Kathleen M. Gura, David C. Bellinger, Alan D. Woolf. . (2017) Blood and Hair Aluminum Levels, Vaccine History, and Early Infant Development: A Cross-Sectional Study. Academic Pediatrics.
CrossRef4
Amanda R. Hall, Chris J. Arnold, Grant G. Miller, Gordon A. Zello. . (2017) Infant Parenteral Nutrition Remains a Significant Source for Aluminum Toxicity. Journal of Parenteral and Enteral Nutrition 41:7, 1228-1233.
CrossRef5
Berkeley N. Limketkai, Monica Choe, Shruti Patel, Neha D. Shah, Valentina Medici. . (2017) Nutritional Risk Factors in the Pathogenesis of Parenteral Nutrition-Associated Liver Disease. Current Nutrition Reports 64.
CrossRef6
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CrossRef7
R.K. Huston, J.W. Kaempf, M. Wang, L. Wang, G.L. Grunkemeier, H.S. Cohen. . (2017) Calcium chloride in neonatal parenteral nutrition: A 15 year experience. Journal of Neonatal-Perinatal Medicine 10:1, 33-38.
CrossRef8
Robert K. Huston, Carl F. Heisel, Benjamin R. Vermillion, J. Mark Christensen, Leah Minc. . (2017) Aluminum Content of Neonatal Parenteral Nutrition Solutions. Nutrition in Clinical Practice 32:2, 266-270.
CrossRef9
Shaye Kivity, Maria-Teresa Arango, Nicolás Molano-González, Miri Blank, Yehuda Shoenfeld. . (2017) Phospholipid supplementation can attenuate vaccine-induced depressive-like behavior in mice. Immunologic Research 65:1, 99-105.
CrossRef10
Robert A. Yokel, Jason M. Unrine. . (2017) Aluminum and Phthalates in Calcium Gluconate. Journal of Pediatric Gastroenterology and Nutrition 64:1, 109-114.
CrossRef11
Collin Anderson, Mark MacKay. . (2016) Physical Compatibility of Calcium Chloride and Sodium Glycerophosphate in Pediatric Parenteral Nutrition Solutions. Journal of Parenteral and Enteral Nutrition 40:8, 1166-1169.
CrossRef12
Victoria Lima-Rogel, Silvia Romano-Moreno, Esperanza de Jesús López-López, Francisco de Jesús Escalante-Padrón, Gilberto Fabian Hurtado-Torres. . (2016) Aluminum Contamination in Parenteral Nutrition Admixtures for Low-Birth-Weight Preterm Infants in Mexico. Journal of Parenteral and Enteral Nutrition 40:7, 1014-1020.
CrossRef13
L. Grangeot-Keros. . (2016) Les adjuvants aluminiques : le point en 2016. Journal de Pédiatrie et de Puériculture 29:4, 215-235.
CrossRef14
Abdul Haleem Panhwar, Tasneem Gul Kazi, Naeemullah, Hassan Imran Afridi, Faheem Shah, Mohammad Balal Arain, Salma Aslam Arain. . (2016) Evaluated the adverse effects of cadmium and aluminum via drinking water to kidney disease patients: Application of a novel solid phase microextraction method. Environmental Toxicology and Pharmacology 43, 242-247.
CrossRef15
Abdul Haleem Panhwar, Tasneem Gul Kazi, Hassan Imran Afridi, Salma Aslam Arain, Mariam Shahzadi Arain, Kapil Dev Brahaman, Naeemullah, Sadaf Sadia Arain. . (2016) Correlation of cadmium and aluminum in blood samples of kidney disorder patients with drinking water and tobacco smoking: related health risk. Environmental Geochemistry and Health 38, 265-274.
CrossRef16
Victor Villarreal, Maria J. Castro. . 2016. Exposure to Lead and Other Heavy Metals: Child Development Outcomes. Pediatric Neurotoxicology, 143-165.
CrossRef17
William R. Mundy, Stephanie Padilla, Joseph M. Breier, Kevin M. Crofton, Mary E. Gilbert, David W. Herr, Karl F. Jensen, Nicholas M. Radio, Kathleen C. Raffaele, Kelly Schumacher, Timothy J. Shafer, John Cowden. . (2015) Expanding the test set: Chemicals with potential to disrupt mammalian brain development. Neurotoxicology and Teratology 52, 25-35.
CrossRef18
Jacob M. Taylor, Leah Oladitan, Susan Carlson, Jill M. Hamilton-Reeves. . (2015) Renal formulas pretreated with medications alters the nutrient profile. Pediatric Nephrology 30, 1815-1823.
CrossRef19
Robert K. Huston, J. Mark Christensen, Sultan M. Alshahrani, Sumeia M. Mohamed, Sara M. Clark, Jeffrey A. Nason, Ying Xing Wu, Josef Neu. . (2015) Calcium Chloride in Neonatal Parenteral Nutrition Solutions with and without Added Cysteine: Compatibility Studies Using Laser and Micro-Flow Imaging Methodology. PLOS ONE 10:8, e0136894.
CrossRef20
Glenda Courtney-Martin, Christina Kosar, Alison Campbell, Yaron Avitzur, Paul W. Wales, Karen Steinberg, Debra Harrison, Kathryn Chambers. . (2015) Plasma Aluminum Concentrations in Pediatric Patients Receiving Long-Term Parenteral Nutrition. Journal of Parenteral and Enteral Nutrition 39:5, 578-585.
CrossRef21
Lucija Tomljenovic, Christopher A. Shaw. . 2015. Answers to Common Misconceptions Regarding the Toxicity of Aluminum Adjuvants in Vaccines. Vaccines and Autoimmunity, 43-56.
CrossRef22
Janelle Santos, Sarah E. Pearce, Annemarie Stroustrup. . (2015) Impact of hospital-based environmental exposures on neurodevelopmental outcomes of preterm infants. Current Opinion in Pediatrics 27, 254-260.
CrossRef23
N. D. Embleton, C. Morgan, C. King. . (2015) Balancing the risks and benefits of parenteral nutrition for preterm infants: can we define the optimal composition?. Archives of Disease in Childhood - Fetal and Neonatal Edition 100, F72-F75.
CrossRef24
Bengt Sjögren, Anders Iregren, Johan Montelius, Robert A. Yokel. . 2015. Aluminum. Handbook on the Toxicology of Metals, 549-564.
CrossRef25
Denise Bohrer. . 2015. Aluminum in Subjects Receiving Parenteral Nutrition. Diet and Nutrition in Critical Care, 2049-2064.
CrossRef26
Stephanie Seneff, Nancy Swanson, Chen Li. . (2015) Aluminum and Glyphosate Can Synergistically Induce Pineal Gland Pathology: Connection to Gut Dysbiosis and Neurological Disease. Agricultural Sciences 06:01, 42-70.
CrossRef27
Kathleen M. Gura. . (2014) Aluminum contamination in parenteral products. Current Opinion in Clinical Nutrition and Metabolic Care 17, 551-557.
CrossRef28
Calvin C. Willhite, Nataliya A. Karyakina, Robert A. Yokel, Nagarajkumar Yenugadhati, Thomas M. Wisniewski, Ian M.F. Arnold, Franco Momoli, Daniel Krewski. . (2014) Systematic review of potential health risks posed by pharmaceutical, occupational and consumer exposures to metallic and nanoscale aluminum, aluminum oxides, aluminum hydroxide and its soluble salts. Critical Reviews in Toxicology 44, 1-80.
CrossRef29
Christopher A Shaw, Dan Li, Lucija Tomljenovic. . (2014) Are there negative CNS impacts of aluminum adjuvants used in vaccines and immunotherapy?. Immunotherapy 6:10, 1055-1071.
CrossRef30
Robert K. Huston, J. Mark Christensen, Chanida Karnpracha, Jill E. Rosa, Sara M. Clark, Evelyn A. Migaki, YingXing Wu, Amanda Bruce. . (2014) Calcium Chloride in Neonatal Parenteral Nutrition: Compatibility Studies Using Laser Methodology. PLoS ONE 9:9, e106825.
CrossRef31
Weijiang Wu, Junfei Shao, Hua Lu, Jie Xu, Aihua Zhu, Wenfeng Fang, Guozhen Hui. . (2014) Guard of Delinquency? A Role of Microglia in Inflammatory Neurodegenerative Diseases of the CNS. Cell Biochemistry and Biophysics 70, 1-8.
CrossRef32
Pamela C. Kruger, Patrick J. Parsons, Aubrey L. Galusha, Michelle Morrissette, Robert R. Recker, Lyn J. Howard. . (2014) Excessive Aluminum Accumulation in the Bones of Patients on Long-Term Parenteral Nutrition. Journal of Parenteral and Enteral Nutrition 38:6, 728-735.
CrossRef33
Daniela Fanni, Rossano Ambu, Clara Gerosa, Sonia Nemolato, Nicoletta Iacovidou, Peter Van Eyken, Vassilios Fanos, Marco Zaffanello, Gavino Faa. . (2014) Aluminum exposure and toxicity in neonates: a practical guide to halt aluminum overload in the prenatal and perinatal periods. World Journal of Pediatrics 10, 101-107.
CrossRef34
Mei Yang, Lixin Jiang, Huiping Huang, Shengbo Zeng, Fen Qiu, Miao Yu, Xiaorong Li, Sheng Wei, Qinghua Sun. . (2014) Dietary Exposure to Aluminium and Health Risk Assessment in the Residents of Shenzhen, China. PLoS ONE 9:3, e89715.
CrossRef35
Sohail Ejaz, Khaleeq Anwar, Muhammad Ashraf. . (2014) MRI and neuropathological validations of the involvement of air pollutants in cortical selective neuronal loss. Environmental Science and Pollution Research 21, 3351-3362.
CrossRef36
Christopher A. Shaw, Stephanie Seneff, Stephen D. Kette, Lucija Tomljenovic, John W. Oller, Robert M. Davidson. . (2014) Aluminum-Induced Entropy in Biological Systems: Implications for Neurological Disease. Journal of Toxicology 2014, 1-27.
CrossRef37
Marlei Veiga, Denise Bohrer, Cristina R.R. Banderó, Sandra M.R. Oliveira, Paulo C. do Nascimento, Patrícia Mattiazzi, Carlos F. Mello, Quéli F. Lenz, Mauro S. Oliveira. . (2013) Accumulation, elimination, and effects of parenteral exposure to aluminum in newborn and adult rats. Journal of Inorganic Biochemistry 128, 215-220.
CrossRef38
A Hernández-Sánchez, P Tejada-González, M Arteta-Jiménez. . (2013) Aluminium in parenteral nutrition: a systematic review. European Journal of Clinical Nutrition 67, 230-238.
CrossRef39
Lucija Tomljenovic, Christopher A. Shaw. . (2013) Human papillomavirus (HPV) vaccine policy and evidence-based medicine: Are they at odds?. Annals of Medicine 45, 182-193.
CrossRef40
Paul A. Offit, Frank DeStefano. . 2013. Vaccine safety. Vaccines, 1464-1480.
CrossRef41
Robert Poole, Kevin Pieroni, Shabnam Gaskari, Tessa Dixon, John Kerner. . (2012) Aluminum Exposure in Neonatal Patients Using the Least Contaminated Parenteral Nutrition Solution Products. Nutrients 4, 1566-1574.
CrossRef42
Robert K. Huston, Evelyn A. Migaki. . (2012) Issues Concerning the Safety of Calcium Chloride in Neonatal Parenteral Nutrition. Journal of Parenteral and Enteral Nutrition 36:5, 498-500.
CrossRef43
Evelyn A. Migaki, Brian J. Melhart, Christina J. Dewar, Robert K. Huston. . (2012) Calcium Chloride and Sodium Phosphate in Neonatal Parenteral Nutrition Containing TrophAmine. Journal of Parenteral and Enteral Nutrition 36:4, 470-475.
CrossRef44
Robert K. Huston, Elizabeth A. McCulley, Andrea M. Markell, Carl F. Heisel, Patrick K. Lewallen. . (2012) Neonatal Parenteral Nutrition Containing Calcium Chloride and Sodium Phosphate. ICAN: Infant, Child, & Adolescent Nutrition 4:3, 137-142.
CrossRef45
Gasem M. Abu-Taweel, Jamaan S. Ajarem, Mohammad Ahmad. . (2012) Neurobehavioral toxic effects of perinatal oral exposure to aluminum on the developmental motor reflexes, learning, memory and brain neurotransmitters of mice offspring. Pharmacology Biochemistry and Behavior 101, 49-56.
CrossRef46
L Tomljenovic, CA Shaw. . (2012) Mechanisms of aluminum adjuvant toxicity and autoimmunity in pediatric populations. Lupus 21:2, 223-230.
CrossRef47
Oyebode A. Taiwo, Bernadette Storey-Laubach. . 2012. Aluminum. Patty's Toxicology, 229-256.
CrossRef48
Pamela Cairns. . 2012. Parenteral nutrition. Rennie & Roberton's Textbook of Neonatology, 321-329.
CrossRef49
Nick Bishop, Mary Fewtrell, Nicholas C. Harvey. . 2012. Metabolic Bone Disease in the Neonatal Period and its Later Sequelae. Pediatric Bone, 655-677.
CrossRef50
Mary Fewtrell, Sirinuch Chomtho, Alan Lucas. . 2012. Infant feeding. Rennie & Roberton's Textbook of Neonatology, 277-320.
CrossRef51
Heather Ann Wier, Robert J Kuhn. . (2012) Aluminum Toxicity in Neonatal Parenteral Nutrition: What Can We Do?. Annals of Pharmacotherapy 46:1, 137-140.
CrossRef52
Lucija Tomljenovic, Christopher A. Shaw. . (2011) Do aluminum vaccine adjuvants contribute to the rising prevalence of autism?. Journal of Inorganic Biochemistry 105, 1489-1499.
CrossRef53
Mary S. Fewtrell, Caroline J. Edmonds, Elizabeth Isaacs, Nick J. Bishop, Alan Lucas. . (2011) Aluminium exposure from parenteral nutrition in preterm infants and later health outcomes during childhood and adolescence. Proceedings of the Nutrition Society 70, 299-304.
CrossRef54
Mary Fewtrell. . (2011) Early nutritional predictors of long-term bone health in preterm infants. Current Opinion in Clinical Nutrition and Metabolic Care 14, 297-301.
CrossRef55
Abdulla Alemmari, Grant G. Miller, Chris J. Arnold, Gordon A. Zello. . (2011) Parenteral aluminum induces liver injury in a newborn piglet model. Journal of Pediatric Surgery 46, 883-887.
CrossRef56
Maria R. Mascarenhas, ElizaBeth C. Wallace. . 2011. Parenteral Nutrition. Pediatric Gastrointestinal and Liver Disease, 964-977.e4.
CrossRef57
José L. Domingo. . 2011. Aluminum. Reproductive and Developmental Toxicology, 407-413.
CrossRef58
Jamal Kamalov, David O. Carpenter, Irina Birman. . (2011) Cytotoxicity of Environmentally Relevant Concentrations of Aluminum in Murine Thymocytes and Lymphocytes. Journal of Toxicology 2011, 1-7.
CrossRef59
Shelle-Ann M Burrell, Christopher Exley. . (2010) There is (still) too much aluminium in infant formulas. BMC Pediatrics 10:1.
CrossRef60
Daniela Dimer Leffa, Adriani Paganini Damiani, Juliana Silva, Jairo José Zocche, Carla Eliete Iochims Santos, Liana Appel Boufleur, Johnny Ferraz Dias, Vanessa Moraes Andrade. . (2010) Evaluation of the Genotoxic Potential of the Mineral Coal Tailings Through the Helix aspersa (Müller, 1774). Archives of Environmental Contamination and Toxicology 59, 614-621.
CrossRef61
Jairo José Zocche, Daniela Dimer Leffa, Adriani Paganini Damiani, Fernando Carvalho, Rodrigo Ávila Mendonça, Carla Eliete Iochims dos Santos, Liana Appel Boufleur, Johnny Ferraz Dias, Vanessa Moraes de Andrade. . (2010) Heavy metals and DNA damage in blood cells of insectivore bats in coal mining areas of Catarinense coal basin, Brazil. Environmental Research 110, 684-691.
CrossRef62
Denise Bohrer, Sandra MR Oliveira, Solange C Garcia, Paulo C Nascimento, Leandro M Carvalho. . (2010) Aluminum Loading in Preterm Neonates Revisited. Journal of Pediatric Gastroenterology and Nutrition 51, 237-241.
CrossRef63
Kathleen M. Gura. . (2010) Aluminum contamination in products used in parenteral nutrition: Has anything changed?. Nutrition 26, 585-594.
CrossRef64
Sandra R. de Oliveira, Denise Bohrer, Solange C. Garcia, Paulo C?cero do Nascimento, Simone Noremberg. . (2010) Aluminum Content in Intravenous Solutions for Administration to Neonates. Journal of Parenteral and Enteral Nutrition 34:3, 322-328.
CrossRef65
Robert L Poole, Linda Schiff, Susan R Hintz, Allison Wong, Nicol Mackenzie, John A Kerner. . (2010) Aluminum Content of Parenteral Nutrition in Neonates: Measured Versus Calculated Levels. Journal of Pediatric Gastroenterology and Nutrition 50, 208-211.
CrossRef66
Judy L. Aschner, Heather M. Furlong. . 2009. Toxicities Associated with Parenteral Nutrition. General and Applied Toxicology.
CrossRef67
K. Weißer, I. Barth, B. Keller-Stanislawski. . (2009) Sicherheit von Impfstoffen. Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz 52, 1053-1064.
CrossRef68
Tasneem G. Kazi, Nusrat Jalbani, Jameel A. Baig, Hassan I. Afridi, Ghulam A. Kandhro, Mohammad B. Arain, Mohammad K. Jamali, Abdul Q. Shah. . (2009) Determination of toxic elements in infant formulae by using electrothermal atomic absorption spectrometer. Food and Chemical Toxicology 47, 1425-1429.
CrossRef69
Rex O Brown, Laurie M Morgan, Syamal K Bhattacharya, Patti L Johnson, Gayle Minard, Roland N Dickerson. . (2008) Potential Aluminum Exposure from Parenteral Nutrition in Patients with Acute Kidney Injury. Annals of Pharmacotherapy 42:10, 1410-1415.
CrossRef70
Robert L. Poole, Susan R. Hintz, Nicol I. Mackenzie, John A. Kerner. . (2008) Aluminum Exposure From Pediatric Parenteral Nutrition: Meeting the New FDA Regulation. Journal of Parenteral and Enteral Nutrition 32:3, 242-246.
CrossRef71
Moazedi Ahmad Ali, Ehsani Vostacolaee Simin, Chinipardaz Rahim. . (2008) Effect of Oral Aluminum Chloride Administration During Lactation on Short and Long-Term Memory of Their Offspring. Journal of Biological Sciences 8, 767-772.
CrossRef72
Amy E. Gilliam, Mary L. Williams. . 2008. Skin of the Premature Infant. Neonatal Dermatology, 45-57.
CrossRef73
Daniel Krewski, Robert A Yokel, Evert Nieboer, David Borchelt, Joshua Cohen, Jean Harry, Sam Kacew, Joan Lindsay, Amal M Mahfouz, Virginie Rondeau. . (2007) Human Health Risk Assessment for Aluminium, Aluminium Oxide, and Aluminium Hydroxide. Journal of Toxicology and Environmental Health, Part B 10, 1-269.
CrossRef74
Pamela C. Kruger, Patrick J. Parsons. . (2007) Determination of serum aluminum by electrothermal atomic absorption spectrometry: A comparison between Zeeman and continuum background correction systems. Spectrochimica Acta Part B: Atomic Spectroscopy 62, 288-296.
CrossRef75
BENGT SJÖGREN, ANDERS IREGREN, CARL-GUSTAF ELINDER, ROBERT A. YOKEL. . 2007. Aluminum. Handbook on the Toxicology of Metals, 339-352.
CrossRef76
M. Patricia Fuhrman. . (2006) Micronutrient Assessment in Long-Term Home Parenteral Nutrition Patients. Nutrition in Clinical Practice 21:6, 566-575.
CrossRef77
Denise Bohrer, Vania Gabbi Polli, Paulo Cícero do Nascimento, Jean Karlo A. Mendonça, Leandro Machado Carvalho, Solange Garcia Pomblum. . (2006) Ion-exchange and potentiometric characterization of Al–cystine and Al–cysteine complexes. JBIC Journal of Biological Inorganic Chemistry 11, 991-998.
CrossRef78
Kathleen M Gura, Mark Puder. . (2006) Recent developments in aluminium contamination of products used in parenteral nutrition. Current Opinion in Clinical Nutrition and Metabolic Care 9, 239-246.
CrossRef79
Pragya Sharma, Kaushala Prasad Mishra. . (2006) Aluminum-induced maternal and developmental toxicity and oxidative stress in rat brain: Response to combined administration of Tiron and glutathione. Reproductive Toxicology 21, 313-321.
CrossRef80
Yong , Raymund L. , Holmes , Daniel T. , Sreenivasan , Gayatri M. , . . (2006) Aluminum Toxicity Due to Intravenous Injection of Boiled Methadone. New England Journal of Medicine 354:11, 1210-1211.
Free Full Text81
Lara E Storms, Michael F Chicella, James E Dice. . (2006) Sevelamer Therapy for Pediatric End-Stage Renal Disease. Pharmacotherapy 26, 410-413.
CrossRef82
C. Gourier-Fréry, N. Fréry. . (2006) Aluminium. EMC - Pathologie professionnelle et de l 'environnement 1, 1-10.
CrossRef83
Ursula Felderhoff-Mueser, Christoph Bührer. . (2005) Clinical measures to preserve cerebral integrity in preterm infants. Early Human Development 81, 237-244.
CrossRef84
Katherine E. Marks, Catherine M. Crill. . (2004) Calcium and Phosphorous in Pediatric Parenteral Nutrition. Journal of Pharmacy Practice 17:6, 432-446.
CrossRef85
S Yumoto, H Nagai, K Kobayashi, W Tada, T Horikawa, H Matsuzaki. . (2004) 26Al incorporation into the tissues of suckling rats through maternal milk. Nuclear Instruments and Methods in Physics Research Section B: Beam Interactions with Materials and Atoms 223-224, 754-758.
CrossRef86
Arezoo Campbell, Stephen Bondy. . 2004. Genetic and Toxicological Models of Neurodegenerative Diseases. Molecular Neurotoxicology, 107-121.
CrossRef87
A. Campbell, A. Becaria, D.K. Lahiri, K. Sharman, S.C. Bondy. . (2004) Chronic exposure to aluminum in drinking water increases inflammatory parameters selectively in the brain. Journal of Neuroscience Research 75:10.1002/jnr.v75:4, 565-572.
CrossRef88
Naoki FUJITA, Hideki KOBAYASHI, Toshiyuki ENAMI, Norikazu NAGAE, Noah CHARLESTON. . (2004) Sensitive determination of aluminum in parenteral solutions and injections by HPLC with fluorescence detection using lumogallion. BUNSEKI KAGAKU 53, 17-23.
CrossRef89
Sakae Yumoto, Hisao Nagai, Koichi Kobayashi, Akiko Tamate, Shigeo Kakimi, Hiroyuki Matsuzaki. . (2003) 26Al incorporation into the brain of suckling rats through maternal milk. Journal of Inorganic Biochemistry 97, 155-160.
CrossRef90
I. Navarro-Blasco, J. I. Alvarez-Galindo. . (2003) Aluminium content of Spanish infant formula. Food Additives and Contaminants 20, 470-481.
CrossRef91
Emmanuelle Advenier, Caroline Landry, Virginie Colomb, Cécile Cognon, Dominique Pradeau, Maurice Florent, Olivier Goulet, Claude Ricour, Odile Corriol. . (2003) Aluminum Contamination of Parenteral Nutrition and Aluminum Loading in Children on Long-Term Parenteral Nutrition. Journal of Pediatric Gastroenterology and Nutrition 36, 448-453.
CrossRef92
Claudia M Reinke, J??rg Breitkreutz, Hans Leuenberger. . (2003) Aluminium in Over-the-Counter Drugs. Drug Safety 26, 1011-1025.
CrossRef93
A Becaria, A Campbell, SC Bondy. . (2002) Aluminum as a toxicant. Toxicology and Industrial Health 18:7, 309-320.
CrossRef94
Mari S. Golub, Wei Zhang, Carl L. Keen, Tzipora Goldkorn. . (2002) Cellular actions of Al at low (1.25 μM) concentrations in primary oligodendrocyte culture. Brain Research 941, 82-90.
CrossRef95
Denise Bohrer, Paulo Cı́cero do Nascimento, Patrı́cia Martins, Regina Binotto. . (2002) Availability of aluminum from glass and an Al form ion exchanger in the presence of complexing agents and amino acids. Analytica Chimica Acta 459, 267-276.
CrossRef96
John Savory, R BruceMartin, Othman Ghribi, Mary Herman. . 2002. Aluminum. Heavy Metals In The Environment.
CrossRef97
Patrick A Ball. . (2002) Do you suffer from “FTI” syndrome?. Nutrition 18, 110-111.
CrossRef98
Kentigern Thorburn, Mahil Samuel, Elisabeth Anne Smith, Paul Baines. . (2001) Aluminum accumulation in critically ill children on sucralfate therapy. Pediatric Critical Care Medicine 2, 247-249.
CrossRef99
Mari S Golub, Stacey L Germann. . (2001) Long-term consequences of developmental exposure to aluminum in a suboptimal diet for growth and behavior of Swiss Webster mice. Neurotoxicology and Teratology 23, 365-372.
CrossRef100
Sakae Yumoto, Hisao Nagai, Hiroyuki Matsuzaki, Hiroshi Matsumura, Wataru Tada, Emiko Nagatsuma, Kouichi Kobayashi. . (2001) Aluminium incorporation into the brain of rat fetuses and sucklings. Brain Research Bulletin 55, 229-234.
CrossRef101
Stephen C. Bondy, Arezoo Campbell. . 2001. Oxidative and Inflammatory Properties of Aluminum: Possible Relevance in Alzheimer’s Disease. Aluminium and Alzheimer's Disease, 311-321.
CrossRef102
MariS. Golub. . 2001. Behavioral Studies in Animals: Past and Potential Contribution to the Understanding of the Relationship between Aluminum and Alzheimer’s Disease. Aluminium and Alzheimer's Disease, 169-187.
CrossRef103
Richard Flarend. . 2001. Absorption of Aluminum from Antiperspirants and Vaccine Adjuvants. Aluminium and Alzheimer's Disease, 75-95.
CrossRef104
Michael C Allwood. . (2000) Pharmaceutical aspects of parenteral nutrition: from now to the future. Nutrition 16, 615-618.
CrossRef105
Otto Roman Frey, Ludwig Maier. . (2000) Polyethylene Vials of Calcium Gluconate Reduce Aluminum Contamination of TPN. Annals of Pharmacotherapy 34:6, 811-812.
CrossRef106
Ruth Morley, Vern Farewell. . (2000) Methodological issues in randomized controlled trials. Seminars in Neonatology 5, 141-148.
CrossRef107
Katarzyna Popińska, Jaroslaw Kierkuś, Malgorzata Lyszkowska, Jerzy Socha, Ewa Pietraszek, Witold Kmiotek, Janusz Ksiazyk. . (1999) Aluminum contamination of parenteral nutrition additives, amino acid solutions, and lipid emulsions. Nutrition 15, 683-686.
CrossRef108
Marta Llansola, María-Dolores Miñana, Carmina Montoliu, Rosana Saez, Regina Corbalán, Luigi Manzo, Vicente Felipo. . (1999) Prenatal Exposure to Aluminum Reduces Expression of Neuronal Nitric Oxide Synthase and of Soluble Guanylate Cyclase and Impairs Glutamatergic Neurotransmission in Rat Cerebellum. Journal of Neurochemistry 73:2, 712-718.
CrossRef109
Patrick Ball. . (1999) Principles for formulating parenteral nutrition for neonates. Current Opinion in Clinical Nutrition and Metabolic Care 2, 261-264.
CrossRef110
Sandra Desroches, Fabrice Biron, Guy Berthon. . (1999) Aluminum speciation studies in biological fluids Part 5. A quantitative investigation of Al(III) complex equilibria with desferrioxamine, 2,3-dihydroxybenzoic acid, Tiron, CP20 (L1), and CP94 under physiological conditions, and computer-aided assessment of the aluminum-mobilizing capacities of these ligands in vivo. Journal of Inorganic Biochemistry 75, 27-35.
CrossRef111
Jay F. Mouser, Gordon S. Sacks. . (1999) Vitamin D and Minerals: How Much for Preterm Infants During a Multivitamin Shortage?. Nutrition in Clinical Practice 14:2, 51-57.
CrossRef112
Catherine M. Crill, Emily B. Hak. . (1999) Upper Gastrointestinal Tract Bleeding in Critically Ill Pediatric Patients. Pharmacotherapy 19, 162-180.
CrossRef113
Patrick A Ball. . (1999) Anything else to add?. Nutrition 15, 87-88.
CrossRef114
Gordon L. Klein, Alan M. Leichtner, Melvin B. Heyman. . (1998) Aluminum in Large and Small Volume Parenterals Used in Total Parenteral Nutrition: Response to the Food and Drug Administration Notice of Proposed Rule by the North American Society for Pediatric Gastroenterology and Nutrition. Journal of Pediatric Gastroenterology & Nutrition 27, 457-460.
CrossRef115
Stephen A. McCurdy. . (1998) Does Work in the Aluminum Reclamation Industry Cause Neurobehavioral Abnormalities?. Archives of Environmental Health: An International Journal 53, 312-312.
CrossRef116
Michael C Allwood, Melanie C.J Kearney. . (1998) Compatibility and stability of additives in parenteral nutrition admixtures. Nutrition 14, 697-706.
CrossRef117
P.W. Geissler, C.E. Shulman, R.J. Prince, W. Mutemi, C. Mnazi, H. Friis, B. Lowe. . (1998) Geophagy, iron status and anaemia among pregnant women on the coast of Kenya. Transactions of the Royal Society of Tropical Medicine and Hygiene 92, 549-553.
CrossRef118
Todd Canada, Jon Albrecht. . (1998) Parenteral Calcium Gluconate Supplementation: Efficacious or Potentially Disastrous?. Journal of the American College of Nutrition 17, 401-403.
CrossRef119
Yujiro Kashiwagi, Yu Nakamura, Yasuyuki Miyamae, Ryota Hashimoto, Masatoshi Takeda. . (1998) Pulse exposure of cultured rat neurons to aluminum-maltol affected the axonal transport system. Neuroscience Letters 252, 5-8.
CrossRef120
Jonathan Borak, John Pierce Wise. . (1998) Does aluminum exposure of pregnant animals lead to accumulation in mothers or their offspring?. Teratology 57:10.1002/(SICI)1096-9926(199803)57:3<>1.0.CO;2-6, 127-139.
CrossRef121
(1997) Aluminum Toxicity in Preterm Infants. New England Journal of Medicine 337:15, 1090-1091.
Free Full Text122
J Gordon Millichap. . (1997) Perinatal IV Aluminum and Developmental Delay. Pediatric Neurology Briefs 11:6, 41.
CrossRef
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