Sources of clinically significant neonatal intensive care unit phthalate exposure

Stroustrup, Annemarie; Bragg, Jennifer; Busgang, Stefanie A.; Andra, Syam S.; Curtin, Paul; Spear, Emily; Just, Allan C.; Arora, Manish; Gennings, Chris

doi:10.1038/s41370-018-0069-2

Cited by 39 publications

(39 citation statements)

References 67 publications

(96 reference statements)

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“…In models accounting for concurrent equipment use, exposure to respiratory support was associated with DEHP biomarkers 50%–136% higher in exposed compared with unexposed infants (p=0.007–0.036). Phthalate mixtures clinically relevant to neurobehavioural development were significantly associated with non-invasive respiratory support 92. This finding allows efforts to mitigate exposure to clinically relevant phthalate mixtures through improvements in medical material composition.…”

Section: Findings To Datementioning

confidence: 87%

“…Phase I produced the first evidence of the clinical impact of phthalate exposure in the NICU population 26. Further study identified specific sources of exposure to clinically relevant phthalate mixtures in the NICU 92…”

Section: Findings To Datementioning

confidence: 99%

“…As our goal of risk reduction in the NICU necessitates identifying specific sources of exposure, we sought to identify sources of the clinically relevant phthalate mixture exposure we previously identified 26 92. In models accounting for concurrent equipment use, exposure to respiratory support was associated with DEHP biomarkers 50%–136% higher in exposed compared with unexposed infants (p=0.007–0.036).…”

Section: Findings To Datementioning

confidence: 99%

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Cohort profile: the Neonatal Intensive Care Unit Hospital Exposures and Long-Term Health (NICU-HEALTH) cohort, a prospective preterm birth cohort in New York City

et al. 2019

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PurposeThe Neonatal Intensive Care Unit Hospital Exposures and Long-Term Health (NICU-HEALTH) longitudinal preterm birth cohort studies the impact of the NICU exposome on early-life development. NICU-HEALTH collects multiple biospecimens, complex observational and survey data and comprehensive multisystem outcome assessments to allow measurement of the impact of modifiable environmental exposures during the preterm period on neurodevelopmental, pulmonary and growth outcomes.ParticipantsModerately preterm infants without genetic or congenital anomalies and their mothers are recruited from an urban academic medical centre level IV NICU in New York City, New York, USA. Recruitment began in 2011 and continues through multiple enrolment phases to the present with goal enrolment of 400 infants. Follow-up includes daily data collection throughout the NICU stay and six follow-up visits in the first 2 years. Study retention is 77% to date, with the oldest patients turning age 8 in 2019.Findings to dateNICU-HEALTH has already contributed significantly to our understanding of phthalate exposure in the NICU. Phase I produced the first evidence of the clinical impact of phthalate exposure in the NICU population. Further study identified specific sources of exposure to clinically relevant phthalate mixtures in the NICU.Future plansFollow-up from age 3 to 12 is co-ordinated through integration with the Environmental Influences on Child Health Outcomes (ECHO) programme. The NICU-HEALTH cohort will generate a wealth of biomarker, clinical and outcome data from which future studies of the impact of early-life chemical and non-chemical environmental exposures can benefit. Findings from study of this cohort and other collaborating environmental health cohorts will likely translate into improvements in the hospital environment for infant development.Trial registration numbersThis observational cohort is registered with ClinicalTrials.gov (NCT01420029andNCT01963065).

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Section: Findings To Datementioning

confidence: 87%

Section: Findings To Datementioning

confidence: 99%

Section: Findings To Datementioning

confidence: 99%

See 1 more Smart Citation

Cohort profile: the Neonatal Intensive Care Unit Hospital Exposures and Long-Term Health (NICU-HEALTH) cohort, a prospective preterm birth cohort in New York City

et al. 2019

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“…There have been associations of phthalate exposure and increased blood pressure in children, including mention of the association in the recent clinical practice guideline released by the American Academy of Pediatrics about screening and management of high blood pressure. [36][37][38][39][40][41] The strengths of our study are several. Our laboratory is experienced in performing reproducible PFTs and correlating them with clinical outcomes.…”

Section: Discussionmentioning

confidence: 99%

<p>Pulmonary function and systolic blood pressure in very low birth weight infants at 34–36 weeks of corrected age</p>

Gievers

Jenkins

Laird

et al. 2019

RRN

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Purpose: Preterm infants are at increased risk of systemic hypertension compared to term infants. Bronchopulmonary dysplasia (BPD) has been shown to be associated with hypertension in preterm infants albeit with no causation reported. BPD is characterized by abnormal pulmonary function tests (PFTs), specifically elevated passive respiratory resistance (Rrs), decreased passive respiratory compliance (Crs), and decreased functional residual capacity (FRC). There have been no studies comparing PFTs in very low birth weight (VLBW) infants with and without hypertension. We hypothesized that stable VLBW infants with hypertension will have altered PFTs. Patients and methods: Retrospective cohort study of infants <1500 g at birth (VLBW) who had PFTs performed near 34-36 weeks of corrected gestational age (CGA). We excluded infants with congenital anomalies, known hypertensive disorders or those at risk of medication-induced hypertension. Data obtained included PFT parameters (Rrs, Crs, FRC) and mean systolic blood pressure (SBP). Results: Fifty-nine VLBW infants were identified for analysis, 14 with and 45 without hypertension. Hypertensive and normotensive patients were similar in terms of mean gestational age (26.6 vs 27.4 weeks), mean CGA at PFTs (36.1 vs 34.6 weeks) and proportion of BPD (36% vs 36%). The Rrs was significantly higher in hypertensive versus normotensive patients [median Rrs of 0.080 (0.069, 0.090) versus 0.066 (0.054, 0.083) cmH 2 O/mL/s; p=0.04]. There was no difference in systolic blood pressure in the infants with and without BPD. Conclusion: In this cohort of contemporary VLBW infants, those with hypertension had increased Rrs. This finding warrants a prospective study with a larger sample size and longterm follow-up. Plain language summaryPrior work has linked bronchopulmonary dysplasia (a chronic lung disease that is relatively common in the most premature of neonates) to systemic hypertension; however, this link has not been fully elucidated. To add to the limited fund of knowledge surrounding this association, our group compared objective pulmonary function test parameters of premature neonates with and those without systemic hypertension. The findings of our work demonstrate that there is commonly an increase in the airway resistance in those with systemic hypertension compared to those without. We speculate that since adequate vascular development within the lungs and kidneys promotes growth, there could be a common developmental issue within the lung and kidney causing the altered lung mechanics and elevated blood pressure, but this will require further study.

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“…Furthermore, the combined exposure of NICU infants to other EDCs besides BPA and BPs, such as phthalates, should be taken in consideration. Previous studies have reported the exposure of VLBW and LBW newborns to phthalates in NICUs (Calafat et al 2004;Green et al 2005;Stroustrup et al 2018b;Weuve et al 2006), suggesting that it impacts neurobehavioral performance (Stroustrup et al 2018a).…”

Section: Introductionmentioning

confidence: 99%

Presence of Bisphenol A and Parabens in a Neonatal Intensive Care Unit: An Exploratory Study of Potential Sources of Exposure

Iribarne-Durán

Artacho‐Cordón

Peña‐Caballero

et al. 2019

Environ Health Perspect

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BACKGROUND: Newborns in neonatal intensive care units (NICUs) are in contact with a variety of medical products whose production might include synthetic chemicals with hormonal activity. OBJECTIVES: Our aim was to assess the content of bisphenol A (BPA) and parabens (PBs) and the hormone-like activities of a subset of medical products commonly used in NICUs in prolonged intimate contact with NICU newborns. METHODS: Fifty-two NICU items were analyzed, determining the concentrations of BPA and PBs [methyl-(MeP), ethyl-(EtP), propyl-(PrP), and butylparaben (BuP)] and using the E-Screen and PALM-luciferase assays to measure the in vitro (anti-)estrogenic and (anti-)androgenic activity, respectively, of the extracts. Items found to have elevated BPA/PB content or hormone-like activities were further extracted using leaching methodologies. RESULTS: BPA was found in three-fifths and PBs in four-fifths of tested NICU items, and ∼ 25% and ∼ 10% of extracts evidenced estrogenic and anti-androgenic activity, respectively. The highest BPA content was found in the three-way stopcock (>7:000 ng=g), followed by patterned transparent film dressing, gastro-duodenal feeding tubes, sterile gloves, single-lumen umbilical catheters, and intravenous (IV) infusion extension sets (concentrations ranged from 100 to 700 ng=g BPA). A total PB concentration (P PBs) >100 ng=g was observed in several items, including light therapy protection glasses, patterned transparent film dressing, winged IV catheters, IV infusion extension sets, and textile tape. The highest estrogenic activity [>450 pM estradiol equivalent (E 2 eq)] was found in small dummy nipples, three-way stopcocks, and patterned transparent film dressing and the highest anti-androgenic activity [>5 mM procymidone equivalent units per gram (Proceq=g)] in small dummy nipples and three-way stopcocks. DISCUSSION: According to these findings, neonates might be exposed to multiple sources of BPA and PBs in NICUs via inhalation, dermal, oral, and IV/parenteral routes. There is a need to address the future health implications for these extremely vulnerable patients and to adopt precautionary preventive measures as a matter of urgency.

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Sources of clinically significant neonatal intensive care unit phthalate exposure

Cited by 39 publications

References 67 publications

Cohort profile: the Neonatal Intensive Care Unit Hospital Exposures and Long-Term Health (NICU-HEALTH) cohort, a prospective preterm birth cohort in New York City

Cohort profile: the Neonatal Intensive Care Unit Hospital Exposures and Long-Term Health (NICU-HEALTH) cohort, a prospective preterm birth cohort in New York City

<p>Pulmonary function and systolic blood pressure in very low birth weight infants at 34–36 weeks of corrected age</p>

Presence of Bisphenol A and Parabens in a Neonatal Intensive Care Unit: An Exploratory Study of Potential Sources of Exposure

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