Chemical Exposures and Infant Outcomes in the Neonatal Intensive Care Unit

描述（由申请人提供）：该候选人是一名儿科医生和新生儿学家，致力于研究和补救高危分娩后不良后果的可改变风险因素，特别是异常神经发育结果的环境决定因素。这个职业发展奖项将使她能够通过正式的课程学习和博士的专家指导。Philip Landrigan， Shanna Swan和William ffer，学习成为一名独立调查员所需的知识和技能，研究医院化学物质暴露对婴儿神经行为发育的影响。在实验室研究中，许多工业化学品是已知的神经毒物，但尽管发育中的胎儿和婴儿特别容易受到环境损害，但产前和婴儿接触这些化学品的调查却有限。有了这个职业发展奖项，候选人将：1)获得接触环境毒物的暴露评估和生物标志物测量方法的培训；2)接受使用婴儿神经行为测试方法的培训；3)将吸取的经验教训应用到一个研究项目中，该项目检查接触邻苯二甲酸盐、酚类、镉和锰的生物标志物与婴儿医学和神经行为发育的关系。通过该职业发展奖获得的培训将使候选人能够在新生儿和儿童健康领域的一个研究不足的领域建立学术轨迹，并具有扩展到儿科医疗保健的许多方面的潜在应用。拟议的研究将是首个对新生儿重症监护病房（NICU）化学暴露进行全面、纵向评估的研究，旨在评估这一脆弱、高度暴露人群的临床结果。提出的研究策略是基于医院的极低出生体重婴儿邻苯二甲酸盐暴露（HBPE）研究的结果，这是一项正在进行的基于新生儿重症监护病房的极低出生体重婴儿试点研究。候选人建议利用其运行HBPE研究的经验以及现有HBPE研究生物标本和数据库来(1)确定流行的和相关的NICU化学品暴露；(2)制定并验证暴露清单，根据特定的新生儿重症监护病房暴露对患者进行分类；(3)开展NICU化学品暴露与婴儿躯体和神经发育结局的综合研究。候选人计划使用本研究的结果和Aim 3中积累的患者队列作为未来儿童身体，生殖和神经行为结果与婴儿时期医院化学暴露相关的纵向研究的基础。

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.