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：
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
项目类别：
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

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是一个很大程度上被忽视的化学暴露来源。新生儿，特别是重症监护病房的新生儿，是高度脆弱的人群，可能患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涉及体外循环 (CPB) 的心脏手术后，暴露量已被证明会增加新生儿和儿童，并已在新生儿重症监护使用的常见医疗器械中检出单位。妊娠期接触这些化学物质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最常见和最严重的后果。尽管已知医疗机构和体外循环设备中存在这些化学物质，但没有研究表明评估手术期间暴露对术后结果和神经发育的影响。使用对接受心脏手术的新生儿群体完成的一项随机对照试验的纵向分析与 CPB 合作，我们建议描述双酚和邻苯二甲酸酯暴露轨迹的特征通过测量术前、4 小时和 24 小时收集的连续尿液样本中的生物标志物来进行心脏手术术后。我们将评估暴露与早期临床结果的关联（先前验证的发病率-死亡率复合结果、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期间的邻苯二甲酸盐暴露可能是改善术后和康复的新途径这个高度脆弱的新生儿群体的神经发育结果。