Circulating phthalates during critical illness in children are associated with long-term attention deficit: a study of a development and a validation cohort

Verstraete, Sören; Vanhorebeek, Ilse; Covaci, Adrian; Güiza, Fabián; Malarvannan, Govindan; Jorens, Philippe G.; Berghe, Greet Van den

doi:10.1007/s00134-015-4159-5

Cited by 61 publications

(97 citation statements)

References 49 publications

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“…Forty-two percent received parenteral nutrition, and the median ICU lengthof-stay was 3 days. In 2012, Mesotten et al [6] reported the neurocognitive developmental follow-up of 456 subjects (65 %) from the original cohort [1]. These children had on average a 15-point reduction in intelligence quotient 4 years post-ICU treatment [6,7].…”

Section: The Study Cohortmentioning

confidence: 99%

“…Findings for the Amsterdam Neuropsychological Tasks System (a measure of attention, motor coordination and executive function) were also abnormal. In this recent study of Verstraete et al [1], neurocognitive outcome was assessed in 449 children (64 % of the 700 critically ill patients recruited to the original study) in relation to the plasma DEHP concentration during the original period of critical illness [2]; 89 % of the children included in this 2016 study had undergone cardiac or other surgery or treatment for trauma. Therefore, follow-up analyses [1,6] involved predominantly postsurgical cases (approx.…”

Section: The Study Cohortmentioning

confidence: 99%

“…Thus, multiple, interrelated factors are associated with neurocognitive outcomes in the post-ICU population with congenital heart disease. The question which needs to be carefully considered is whether phthalates should be added to this list, or is the "harmful" association with DEHP exposure reported by Verstraete et al [1] related to factors such as duration of cardiopulmonary bypass and ICU length-ofstay and, consequently, the need for repeated exposure to blood transfusion and blood product bags, or to parenteral nutrition. Furthermore, the method used by these authors to compile their data on DEHP exposure, namely, the product of the plasma concentration on the last day of ICU admission and the ICU length-of-stay [1], means it cannot be related to the TDI and NOAEL for DEHP.…”

Section: The Study Cohortmentioning

confidence: 99%

“…In a recent article in Intensive Care Medicine, Verstraete et al [1] report an association between "Iatrogenic exposure to circulating phthalates during treatment in intensive care and attention deficit observed 4 years after pediatric critical illness" in 449 previous recruits to a randomized controlled trial [2]. These results have the potential to become a major focus of controversy and alarm.…”

Section: Introductionmentioning

confidence: 99%

“…These results have the potential to become a major focus of controversy and alarm. To better understand how intensivists are to use this information in ICU practice, in this editorial we consider the following: (1) our current understanding of potential phthalate toxicity; (2) the history of research underpinning the study of Verstraete et al [1] and its characteristics; (3) current regulations on di(2-ethylhexyl)phthalate (DEHP) in medical devices.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Dealing with phthalates in medical devices: a case of primum non nocere (first do no harm)?

Tasker

Sharpe

2016

Intensive Care Med

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Section: The Study Cohortmentioning

confidence: 99%

Section: The Study Cohortmentioning

confidence: 99%

Section: The Study Cohortmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Dealing with phthalates in medical devices: a case of primum non nocere (first do no harm)?

Tasker

Sharpe

2016

Intensive Care Med

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Assessment of Long-term Psychological Outcomes After Pediatric Intensive Care Unit Admission

Poh

Heng

et al. 2022

JAMA Pediatr

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The pediatric intensive care unit (PICU) exposes children to stressful experiences with potential long-term psychological repercussions. However, current understanding of post-PICU psychological outcomes is incomplete.OBJECTIVE To systematically review and evaluate reported long-term psychological outcomes among children previously admitted to the PICU.DATA SOURCES A systematic search of the Cumulative Index to Nursing and Allied Health Literature, Embase, MEDLINE (PubMed), and PsycINFO was conducted from database inception to June 2021. Search terms included phrases related to intensive care (eg, intensive care units and critical care) and terms for psychological disorders (eg, posttraumatic stress disorder, depressive disorder, conduct disorder, and neurodevelopmental disorder) limited to the pediatric population.STUDY SELECTION This systematic review and meta-analysis included randomized clinical trials and observational studies reporting psychological disorders among children younger than 18 years who were admitted to the PICU with follow-up for at least 3 months. Psychological disorders were defined using the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition). Children were excluded if they were admitted to the PICU for primary brain conditions (eg, traumatic brain injury, meningoencephalitis, and brain tumors) or discharged to the home for palliative care.DATA EXTRACTION AND SYNTHESIS Titles and abstracts were independently screened by 2 reviewers, with data extraction conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guideline. Data were pooled using a random-effects model during meta-analysis.MAIN OUTCOMES AND MEASURES Age-corrected IQ scores and long-term psychological outcomes measured by scales such as the Child Behavior Checklist (higher scores indicate more behavioral problems) among children admitted to the PICU. RESULTSOf 9193 records identified, 31 independent studies (5 randomized clinical trials and 26 observational studies) involving 7786 children (mean age, 7.3 years [95% CI, years]; 4267 boys [54.8%]; race and ethnicity were not reported by all studies) admitted to the PICU were included. Overall, 1 of 19 children (5.3%) to 14 of 16 children (88.0%) previously admitted to the PICU were reported to have at least 1 psychological disorder. Studies that examined posttraumatic stress disorder reported that 6 of 60 children (10.0%) to 31 of 102 children (30.4%) met the diagnostic criteria for the disorder at 3 to 6 months of follow-up. Compared with healthy children, those admitted to the PICU had lower IQ scores at 1 to 2 years of 89.40 points [95% CI, points] vs 100.70 points [95% CI, 99.43-101.97 points]; P < .001) and 3 to 5 years of follow-up (mean, 88.54 points [95% CI, 83.92-93.16 points] vs 103.18 [95% CI, 100.36-105.99 points]; P < .001) and greater total emotional and behavioral problems at 4 years of follow-up (mean, 51.69 points [95% CI, 50.37-53.01 points] vs 46.66 points [95% CI, points]; P < .001).CONC...

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Bisphenols and phthalates: Plastic chemical exposures can contribute to adverse cardiovascular health outcomes

Ramadan

Cooper

Posnack

2020

Birth Defects Research

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Phthalates and bisphenols are high production volume chemicals that are used in the manufacturing of consumer and medical products. Given the ubiquity of bisphenol and phthalate chemicals in the environment, biomonitoring studies routinely detect these chemicals in 75-90% of the general population. Accumulating evidence suggests that such chemical exposures may influence human health outcomes, including cardiovascular health. These associations are particularly worrisome for sensitive populations, including fetal, infant and pediatric groups-with underdeveloped metabolic capabilities and developing organ systems. In the presented article, we aimed to review the literature on environmental and clinical exposures to bisphenols and phthalates, highlight experimental work that suggests that these chemicals may exert a negative influence on cardiovascular health, and emphasize areas of concern that relate to vulnerable pediatric groups. Gaps in our current knowledge are also discussed, so that future endeavors may resolve the relationship between chemical exposures and the impact on pediatric cardiovascular physiology.

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Circulating phthalates during critical illness in children are associated with long-term attention deficit: a study of a development and a validation cohort

Cited by 61 publications

References 49 publications

Dealing with phthalates in medical devices: a case of primum non nocere (first do no harm)?

Dealing with phthalates in medical devices: a case of primum non nocere (first do no harm)?

Assessment of Long-term Psychological Outcomes After Pediatric Intensive Care Unit Admission

Bisphenols and phthalates: Plastic chemical exposures can contribute to adverse cardiovascular health outcomes

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