Chou Wei-Chun, Gaynor J William, Graham Eric M, Klepczynski Brenna, Walker Tia, Coker Eric S, Ittenbach Richard F, Lin Zhoumeng
Department of Environmental and Global Health, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA.
Center for Environmental and Human Toxicology, University of Florida, Gainesville, Florida, USA.
Environ Health Perspect. 2025 Jun;133(6):67016. doi: 10.1289/EHP15034. Epub 2025 Jun 18.
Plastic-containing medical devices are commonly used in critical care units and other patient care settings. Patients are often exposed to xenobiotic agents that are leached out from plastic-containing medical devices, including bisphenol A (BPA) and phthalates. Given the potential health implications, there is an urgent need for a comprehensive understanding of this exposure.
This multi-institutional study aimed to determine the time-dependent concentrations and analyze the exposure patterns of bisphenol A (BPA) and phthalate metabolites in urine obtained from infants with congenital heart defects (CHD) undergoing cardiac surgery during the perioperative period.
We collected daily urine samples from infants with CHD undergoing cardiac surgery during the perioperative period (from birth to 21 d) and measured BPA, di(2-ethylhexyl)phthalate (DEHP) metabolites (MEHP, MEHHP, MEOHP, MECPP), and non-DEHP phthalate metabolites (MBP, MBzP, MMP, MEP, MCPP) using ultra-high-performance liquid chromatography-tandem mass spectrometry. Machine learning-based cluster analysis was utilized to analyze these time-dependent data.
Utilizing a machine learning-based clustering approach, six distinct clustering groups were identified among infants exhibiting similar time-series toxicokinetic exposure patterns. These distinct clustering groups correlated with the utilization of extracorporeal membrane oxygenation (ECMO) and cardiopulmonary bypass (CPB), as well as the intensity of medical care. Notably, clustering groups associated with ECMO use demonstrated elevated levels of urinary BPA and DEHP metabolites compared to those without ECMO use, a trend not observed with non-DEHP metabolites. Moreover, peak concentrations in toxicokinetic profiles were associated with intensity of medical care.
Our findings suggest that dynamic changes of urinary BPA and DEHP metabolites corresponded to the type and number of medical devices used in infants. Further studies are needed to investigate the potential toxicological risks of infants with CHD undergoing cardiac surgery exposed to these chemicals in medical devices. https://doi.org/10.1289/EHP15034.
含塑料的医疗设备常用于重症监护病房和其他患者护理环境。患者经常接触从含塑料的医疗设备中浸出的外源性物质，包括双酚A（BPA）和邻苯二甲酸盐。鉴于其对健康的潜在影响，迫切需要全面了解这种接触情况。
这项多机构研究旨在确定围手术期接受心脏手术的先天性心脏病（CHD）婴儿尿液中双酚A（BPA）和邻苯二甲酸酯代谢物的时间依赖性浓度，并分析其接触模式。
我们收集了围手术期（从出生到21天）接受心脏手术的CHD婴儿的每日尿液样本，并使用超高效液相色谱-串联质谱法测量BPA、邻苯二甲酸二（2-乙基己基）酯（DEHP）代谢物（MEHP、MEHHP、MEOHP、MECPP）和非DEHP邻苯二甲酸酯代谢物（MBP、MBzP、MMP、MEP、MCPP）。利用基于机器学习的聚类分析来分析这些时间依赖性数据。
采用基于机器学习的聚类方法，在表现出相似时间序列毒代动力学接触模式的婴儿中识别出六个不同的聚类组。这些不同的聚类组与体外膜肺氧合（ECMO）和体外循环（CPB）的使用以及医疗护理强度相关。值得注意的是，与使用ECMO相关的聚类组与未使用ECMO的组相比，尿液中BPA和DEHP代谢物水平升高，而非DEHP代谢物未观察到这种趋势。此外，毒代动力学曲线中的峰值浓度与医疗护理强度相关。
我们的研究结果表明，尿液中BPA和DEHP代谢物的动态变化与婴儿使用的医疗设备类型和数量相对应。需要进一步研究以调查接受心脏手术的CHD婴儿接触医疗设备中这些化学物质的潜在毒理学风险。https://doi.org/10.1289/EHP15034。
