Impact of phthalate and phenol exposures on congenital heart surgery outcomes

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Abstract Industrial contaminants in healthcare settings are a largely overlooked source of chemical exposures. Neonates, particularly those in an intensive care unit, are a highly vulnerable population and may have a heightened risk for greater chemical exposures as well as adverse outcomes. Bisphenol and phthalate exposures have been shown to increase following cardiac surgery involving cardiopulmonary bypass (CPB) in neonates and children and have been detected in common medical devices used in neonatal intensive care units. Gestational exposures to these chemicals have been shown to negatively impact neurodevelopment, which remains the most frequent and significant consequence of congenital heart disease and its treatment. Despite the known presence of these chemicals in healthcare settings and in CPB equipment, no studies have assessed the influence of exposures during surgery on postoperative outcomes and neurodevelopment. Using a longitudinal analysis of a randomized controlled trial completed in a neonate population undergoing cardiac operation with CPB, we propose to characterize trajectories of bisphenol and phthalate exposures in relation to cardiac surgery by measuring biomarkers in serial urine samples collected pre-operation and 4- and 24-hours post-operation. We will assess associations of exposures with early clinical outcomes (a previously validated morbidity-mortality composite outcome, acute kidney injury, hepatic injury, and low cardiac output syndrome) as well as neurodevelopment at 12-months of age. If our hypotheses are confirmed, reducing bisphenol and phthalate exposures during neonatal cardiac surgery may be a new avenue for improving postoperative and neurodevelopmental outcomes in this highly vulnerable neonatal population.