Paediatric environmental health history taking: why bother?

Immuno-Hormonal, Genetic and Metabolic Profiling of Newborns as a Basis for the Life-Long OneHealth Medical Record: A Scoping Review

Holistic and life-long medical surveillance is the core of personalised medicine and supports an optimal implementation of both preventive and curative healthcare. Personal medical records are only partially unified by hospital or general practitioner informatics systems, but only for citizens with long-term permanent residence. Otherwise, insight into the medical history of patients greatly depends on their medical archive and memory. Additionally, occupational exposure records are not combined with clinical or general practitioner records. Environmental exposure starts preconceptionally and continues during pregnancy by transplacental exposure. Antenatal exposure is partially dependent on parental lifestyle, residence and occupation. Newborn screening (NBS) is currently being performed in developed countries and includes testing for rare genetic, hormone-related, and metabolic conditions. Transplacental exposure to substances such as endocrine disruptors, air pollutants and drugs may have life-long health consequences. However, despite the recognised impact of transplacental exposure on the increased risk of metabolic syndrome, neurobehavioral disorders as well as immunodisturbances including allergy and infertility, not a single test within NBS is geared toward detecting biomarkers of exposure (xenobiotics or their metabolites, nutrients) or effect such as oestradiol, testosterone and cytokines, known for being associated with various health risks and disturbed by transplacental xenobiotic exposures. The outcomes of ongoing exposome projects might be exploited to this purpose. Developing and using a OneHealth Medical Record (OneHealthMR) may allow the incorporated chip to harvest information from different sources, with high integration added value for health prevention and care: environmental exposures, occupational health records as well as diagnostics of chronic diseases, allergies and medication usages, from birth and throughout life. Such a concept may present legal and ethical issues pertaining to personal data protection, requiring no significant investments and exploits available technologies and algorithms, putting emphasis on the prevention and integration of environmental exposure and health data.

Children's environmental health and the precautionary principle

The concept of precaution has a long history in medicine and public health. The modern precautionary principle (PP), originating from environmental debates in Germany in the 1970s, has been included in many international agreements, such as the Treaty on European Union. PP is a public policy tool that justifies actions, which protect human health and the environment in face of uncertain risks. The outcome of the application of PP depends on the level, nature, and distribution of acceptable risks and on the availability of alternatives, and can range from taking no action to banning of substances or the activities of concern. Given the complex nature and uncertainty of environmental risks to children's health, a precautionary approach is warranted. Public health professionals and clinical practitioners could adopt such an approach within the wider context of considering the environment as a source of risks to children's health. Relevant knowledge and skills are needed to enable health care professionals to address these issues. New methodological and scientific approaches are necessary to make use of scattered, but potentially relevant clinical evidence in providing 'early warnings' of health hazards.