Selenium deficiency in children and adolescents nourished by parenteral nutrition and/or selenium-deficient enteral formula

The authors analyzed serum selenium levels of 95 children and adolescents with intestinal dysfunction and/or neurological disabilities [age range: 7 months-20 years; mean standard deviation (SD): 8.0 +/- 5.3 years] who received parenteral nutrition (PN) and/or enteral nutrition (EN) with either reduced or no selenium doses for more than 3 months. Twenty-eight patients (29%) showed serum selenium levels below 4.0 mu g/dL. Five patients whose serum selenium levels were below 2 mu g/dL presented various clinical manifestations, including hair browning (n = 5), macrocythemia (n = 4), nail whitening (n = 3) and cardiac dysfunction (n = 1). None of these 5 patients were nourished through ordinary diets. Three of these patients were nourished through selenium-free enteral nutritional products, 1 through selenium-deficient PN and 1 through PN and a formula with reduced selenium. After selenium supplement therapy for 1 year, all 5 patients exhibited improvement in their serum selenium levels and clinical features of selenium deficiency. It is important to be cautious about secondary selenium deficiency in children and adolescents nourished only through EN/PN without an adequate dose of selenium. (C) 2014 Elsevier GmbH. All rights reserved.