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

邻苯二甲酸盐和苯酚暴露对先天性心脏病手术结果的影响。

• 批准号: 10852165
• 负责人: Jordan Richard Kuiper
• 金额: $ 21.36万
• 依托单位: GEORGE WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-05-18 至 2025-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10852165
• 关键词: Acute Renal Failure with Renal Papillary Necrosis; Address; Adrenal Cortex Hormones; Age Months; Biological Markers; Brain Injuries; Cardiac; Cardiac Surgery procedures; Cardiopulmonary Bypass; Cessation of life; Chemical Exposure; Chemicals; Child; Clinical; Cognition; Congenital Abnormality; Congenital Heart Defects; Data; Development; Endocrine Disruptors; Epidemiologist; Equipment; Exposure to; Extracorporeal Membrane Oxygenation; Focal Brain Injuries; Goals; Health; Heart Arrest; Hippocampus; Hospitals; Hour; Impairment; Industrialization; Infant; Injury to Kidney; Intensive Care Units; Intervention; Investigation; Language; Life; Low Cardiac Output Syndrome; Measures; Medical; Medical Care Costs; Medical Device; Morbidity - disease rate; Motor Skills; Mus; Neonatal; Neonatal Intensive Care Units; Neurodevelopmental Deficit; Neurons; Operative Surgical Procedures; Outcome; Patients; Perioperative; Phenols; Plasticizers; Plastics; Polyvinyl Chloride; Population; Postoperative Period; Pregnancy; Randomized, Controlled Trials; Risk; Role; Sampling; Socioeconomic Factors; Source; Specimen; Surgical incisions; Time; Toddler; Urine; Vulnerable Populations; adverse outcome; chemical association; chemical reduction; congenital heart disorder; cost effective; early life exposure; epidemiology study; evidence base; follow-up; health care settings; heart function; improved; liver injury; longitudinal analysis; manufacture; mortality; neonate; neurodevelopment; novel; operation; pediatric cardiologist; perioperative morbidity; phthalates; polycarbonate; primary outcome; secondary outcome; surgery outcome; urinary

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.

摘要 医疗环境中的工业污染物是一个很大程度上被忽视的化学品暴露源。 新生儿，特别是那些在重症监护病房，是一个非常脆弱的人群，可能有一个 更大的化学品接触风险以及不利后果。双酚和邻苯二甲酸酯 在涉及心肺转流（CPB）的心脏手术后， 在新生儿重症监护中使用的常见医疗器械中检测到 单位暴露于这些化学物质的锗已被证明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的最常见和最重要的后果。 尽管已知这些化学物质存在于医疗机构和CPB设备中，但没有研究表明 评估了手术期间暴露对术后结局和神经发育的影响。使用 在接受心脏手术的新生儿人群中完成的随机对照试验的纵向分析 CPB操作，我们建议表征双酚和邻苯二甲酸酯暴露的轨迹， 通过测量术前和术后4小时和24小时收集的系列尿样中的生物标志物进行心脏手术 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-死亡率复合结局、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 邻苯二甲酸酯暴露在新生儿心脏手术可能是一种新的途径， 神经发育的结果在这个高度脆弱的新生儿群体。