Aluminum Toxicity in Preterm Infants

To the Editor: The observation by Bishop et al. (May 29 issue) 1 regarding aluminum contamination of hyperalimentation solutions is interesting, but we would like to point out several limitations of the study design and analysis. First, toxicity may be a function of serum aluminum concentrations, but these were not measured. The underlying assumption that increased intake leads to increased serum concentrations may not be valid; Koo et al. found no difference in serum aluminum concentrations in preterm neonates with various levels of aluminum intake. 2 Increased intake could be offset by an increase in urinary excretion; without measuring the latter, this . . .