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The benzyl alcohol preservative has been linked to severe toxicity in this population, including a potentially fatal condition known as gasping syndrome. Newborns have immature metabolic pathways and cannot efficiently metabolize benzyl alcohol, leading to its accumulation and metabolic acidosis with respiratory failure in severe cases

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Of 492 patients identified, 382 (78%) were receiving injections more frequently than the recommended three monthly dose of hydroxocobalamin

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