Impact of phthalate and phenol exposures on congenital heart surgery outcomes.

摘要 医疗保健环境中的工业污染物是化学暴露的一个很大程度上被忽视的来源。 新生儿，特别是那些在重症监护病房的新生儿，是一个高度脆弱的人群，可能有 更大的化学品暴露以及不良后果的风险增加。双酚和邻苯二甲酸酯 在中国，体外循环(CPB)心脏手术后暴露增加。 新生儿和儿童，并在新生儿重症监护中使用的常见医疗器械中检测到 单位。研究表明，孕期接触这些化学物质会对神经发育产生负面影响， 这仍然是先天性心脏病及其治疗最常见和最重要的后果。 尽管已知在医疗保健环境和CPB设备中存在这些化学物质，但还没有研究 评估术中暴露对术后结果和神经发育的影响。vbl.使用 一项在新生儿心脏手术人群中完成的随机对照试验的纵向分析 在CPB的操作下，我们建议表征双酚和邻苯二甲酸盐暴露的轨迹与 心脏手术前、术后4小时和24小时连续尿样生物标志物的测定 手术后。我们将评估暴露与早期临床结果的相关性(先前验证的 发病率-死亡率综合结果、急性肾损伤、肝损伤和低心输出量综合征) 以及12个月大时的神经发育。如果我们的假设得到证实，减少双酚和 新生儿心脏手术中的邻苯二甲酸盐暴露可能是改善术后和 这一高度脆弱的新生儿群体的神经发育结果。

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.