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

基本信息

批准号：
10452789
负责人：
Jordan Richard Kuiper
金额：
$ 25.91万
依托单位：
JOHNS HOPKINS UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-05-18 至 2023-04-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10452789
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 (Brain)Hospitals Hour Impairment Industrialization Infant Injury to Kidney Intensive Care Units Intervention Investigation Language Lead 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 Savings Socioeconomic Factors Source Specimen Surgical incisions Time Toddler Urine Vulnerable Populations adverse outcome base congenital heart disorder cost effective early life exposure epidemiology study evidence base follow-up health care settings improved liver injury longitudinal analysis mortality neonate neurodevelopment novel operation pediatric cardiologist perioperative morbidity phthalates polycarbonate primary outcome secondary outcome surgery outcome urinary

项目摘要

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.

抽象的医疗保健环境中的工业污染物在很大程度上被忽略了化学暴露的来源。新生儿，尤其是重症监护病房的新生儿，是一个高度脆弱的人口，可能有更大的化学暴露和不良结果的风险增加。双苯酚和邻苯二甲酸盐涉及心肺旁路（CPB）的心脏手术后的暴露已增加新生儿和儿童已在新生儿重症监护中使用的普通医疗设备中检测到单位。已显示对这些化学物质的妊娠暴露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，最重要的后果。尽管已知这些化学物质存在于医疗保健环境和CPB设备中，但没有研究评估了手术期间暴露对术后结局和神经发育的影响。使用对正在接受心脏的新生群体完成的随机对照试验的纵向分析我们建议使用CPB操作，以表征双酚和邻苯二甲酸盐的轨迹通过测量收集预尿样品的生物标志物以及4小时和24小时的生物标志物。手术后。我们将评估与早期临床结果的暴露关联（先前验证的发病率综合结果，急性肾脏损伤，肝损伤和低心输出综合症）以及12个月大的神经发育。如果我们的假设得到确认，则减少了双酚和新生儿心脏手术期间的邻苯二甲酸盐暴露可能是改善术后和在这个高度脆弱的新生儿人群中，神经发育结果。