Toxic metal contamination in parenteral nutrition and blood transfusions in preterm Neonates: Health risk assessment.

Preterm neonates are among the most vulnerable populations in hospital settings, often requiring life-saving interventions such as total parenteral nutrition (TPN) and red blood cell (RBC) transfusions. However, these medical interventions may inadvertently expose infants to toxic metals including lead (Pb), cadmium (Cd), mercury (Hg), and arsenic (As). In this study, we assessed metal levels in 230 TPN and 17 RBC samples administered to 33 preterm neonates at a tertiary care NICU in Riyadh. Our analysis revealed that all samples were contaminated with toxic metals. The median hazard quotient (HQ) for As in TPN was 2, with 80 % of samples exceeding the safety threshold (HQ > 1). The hazard index (HI) exceeded 1 in 92 % of neonates. Notably, all RBC samples exhibited HI > 1, with Pb and Hg accounting for most of the toxic burden. These findings underscore the urgency for regulatory oversight of clinical products and procedures involving neonates and highlight the potential long-term health risks posed by routine NICU interventions.