Division of Newborn Medicine, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
J Expo Sci Environ Epidemiol. 2020 Jan;30(1):137-148. doi: 10.1038/s41370-018-0069-2. Epub 2018 Sep 21.
In the United States each year, more than 300,000 infants are admitted to neonatal intensive care units (NICU) where they are exposed to a chemical-intensive hospital environment during a developmentally vulnerable period. Although multiple studies have demonstrated elevated phthalate biomarkers in NICU patients, specific sources of NICU-based phthalate exposure have not been identified.In this study, premature newborns with birth weight <1500 g were recruited to participate in a prospective environmental health cohort during the NICU hospitalization. Exposure to specific NICU equipment was recorded daily during the NICU hospitalization. One hundred forty-nine urine specimens from 71 infants were analyzed for phthalate metabolites using high-performance liquid chromatography/tandem mass spectrometry.In initial analyses, exposure to medical equipment was directly related to phthalate levels, with DEHP biomarkers 95-132% higher for infants exposed to specific medical equipment types compared to those without that equipment exposure (p < 0.001-0.023). This association was mirrored for clinically relevant phthalate mixtures whether composed of DEHP metabolites or not (p = 0.002-0.007). In models accounting for concurrent equipment use, exposure to respiratory support was associated with DEHP biomarkers 50-136% higher in exposed compared to unexposed infants (p = 0.007-0.036). Phthalate mixtures clinically relevant to neurobehavioral development were significantly associated with non-invasive respiratory support (p = 0.008-0.026). Feeding supplies and intravenous lines were not significantly associated with clinically important phthalate mixtures.Respiratory support equipment may be a significant and clinically relevant NICU source of phthalate exposure. Although manufacturers have altered feeding and intravenous supplies to reduce DEHP exposure, other sources of exposure to common and clinically impactful phthalates persist in the NICU.
在美国，每年有超过 30 万名婴儿被收入新生儿重症监护病房（NICU），他们在发育脆弱期处于一个化学物质密集的医院环境中。尽管多项研究表明 NICU 患者的邻苯二甲酸酯生物标志物水平升高，但尚未确定 NICU 中邻苯二甲酸酯暴露的具体来源。在这项研究中，体重<1500g 的早产儿在 NICU 住院期间被招募参与前瞻性环境健康队列研究。在 NICU 住院期间，每天记录特定 NICU 设备的暴露情况。对 71 名婴儿的 149 份尿液样本进行了高效液相色谱/串联质谱法分析，以检测邻苯二甲酸酯代谢物。在初步分析中，医疗设备的暴露与邻苯二甲酸酯水平直接相关，与未暴露于特定医疗设备的婴儿相比，暴露于特定医疗设备类型的婴儿的 DEHP 生物标志物水平高出 95-132%（p<0.001-0.023）。对于含有 DEHP 代谢物或不含 DEHP 代谢物的临床相关邻苯二甲酸酯混合物，也存在类似的关联（p=0.002-0.007）。在考虑同时使用设备的模型中，与未暴露组相比，暴露于呼吸支持的婴儿的 DEHP 生物标志物水平高出 50-136%（p=0.007-0.036）。与神经行为发育相关的临床相关邻苯二甲酸酯混合物与非侵入性呼吸支持显著相关（p=0.008-0.026）。喂养用品和静脉输液与临床重要的邻苯二甲酸酯混合物无显著相关性。呼吸支持设备可能是 NICU 中邻苯二甲酸酯暴露的一个重要且具有临床意义的来源。尽管制造商已经改变了喂养和静脉输液用品以减少 DEHP 暴露，但 NICU 中仍然存在其他常见且具有临床影响的邻苯二甲酸酯暴露源。
