Chemical Exposures and Infant Outcomes in the Neonatal Intensive Care Unit

描述（由申请人提供）：候选人是一名儿科医生和儿科医生，从事研究职业，专注于研究和补救高危出生后不良结局的可改变风险因素，特别是异常神经发育结果的环境决定因素。这个职业发展奖将使她通过正式的课程和专家指导博士菲利普·兰德里根，莎娜天鹅和威廉·菲弗，发展必要的知识和技能，成为一个独立的研究者研究医院为基础的化学品暴露对婴儿神经行为发育的影响。许多工业化学品在实验室研究中是已知的神经毒物，但产前和婴儿暴露于这些化学品的调查是有限的，尽管事实上，发育中的胎儿和婴儿特别容易受到环境的伤害。有了这个职业发展奖，候选人将：1）获得暴露评估和暴露于环境毒物的生物标志物测量方法的培训; 2）获得使用婴儿神经行为测试方法的培训;和3）将学到的经验教训应用于研究项目，检查暴露于邻苯二甲酸酯，苯酚，镉和锰的生物标志物以及婴儿医学和神经行为发育。通过这个职业发展奖获得的培训将使候选人能够在儿科学和儿童健康领域的研究领域中建立一个学术轨迹，并具有扩展到儿科医疗保健许多方面的潜在应用。拟议的研究将是第一个全面的，纵向评价化学品暴露在新生儿重症监护病房（NICU），旨在评估临床结果，在这个脆弱的，高度暴露的人口。提出的研究策略是基于医院的极低出生体重儿（HBPE）邻苯二甲酸酯暴露研究的产物，该研究是西奈山医院一项正在进行的基于NICU的极低出生体重儿试点研究。候选人建议利用其开展HBPE研究的经验以及现有HBPE研究生物样本和数据库，以（1）确定普遍和相关的NICU化学品暴露;（2）正式制定并验证暴露清单，以根据特定的NICU暴露对患者进行分类;以及（3）对NICU化学品暴露以及婴儿躯体和神经发育结局进行全面研究。候选人计划使用本研究的结果和目标3中收集的患者队列作为未来纵向研究的基础，研究与婴儿期医院化学品暴露相关的儿童躯体、生殖和神经行为结局。

DESCRIPTION (provided by applicant): The candidate is a pediatrician and neonatologist embarking on a research career focused on the study and remediation of modifiable risk factors for adverse outcome following high-risk birth, particularly the environmental determinants of abnormal neurodevelopmental outcomes. This career development award will enable her through formal coursework and expert mentorship by Drs. Philip Landrigan, Shanna Swan, and William Fifer, to develop the knowledge and skills necessary to become an independent investigator studying the impact of hospital-based chemical exposure on infant neurobehavioral development. Many industrial chemicals are known neurotoxicants in laboratory studies, but investigations of prenatal and infant exposure to these chemicals are limited, despite the fact that the developing fetus and infant are particularly susceptible to environmental insults. With this career development award, the candidate will: 1) obtain training in the methods of exposure assessment and biomarker measurements of exposure to environmental toxicants; 2) obtain training in the use of infant neurobehavioral testing methods; and 3) apply the lessons learned to a research project examining biomarkers of exposure to phthalates, phenols, cadmium, and manganese and infant medical and neurobehavioral development. The training received through this career development award will enable the candidate to forge an academic trajectory in what is an under-examined area of study within the fields of neonatology and child health, with potential applications that extend to numerous aspects of pediatric healthcare. The proposed study will be the first comprehensive, longitudinal evaluation of chemical exposure in the neonatal intensive care unit (NICU) designed to evaluate clinical outcomes in this vulnerable, highly exposed population. The Research Strategy proposed is an outgrowth of the Hospital-Based Phthalate Exposure in Very Low Birth Weight Infants (HBPE) study, an ongoing, NICU-based pilot study of very low birth weight infants at the Mount Sinai Hospital. The candidate proposes to capitalize on her experience running the HBPE study and on the existing HBPE study biospecimen and data repositories to (1) identify prevalent and relevant NICU chemical exposures; (2) formalize and validate an exposure checklist to categorize patients by specific NICU exposures; and (3) conduct a comprehensive study of NICU chemical exposure and infant somatic and neurodevelopmental outcomes. The candidate plans to use the results of this study and the patient cohort amassed in Aim 3 as the basis for a future longitudinal study of childhood somatic, reproductive, and neurobehavioral outcomes in relation to hospital- based chemical exposures encountered in infancy.