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Strømmen K, Lyche JL, Moltu SJ, Müller MHB, Blakstad EW, Brække K, Sakhi AK, Thomsen C, Nakstad B, Rønnestad AE, Drevon CA, Iversen PO. Estimated daily intake of phthalates, parabens, and bisphenol A in hospitalised very low birth weight infants. Chemosphere 2022; 309:136687. [PMID: 36206919 DOI: 10.1016/j.chemosphere.2022.136687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 09/18/2022] [Accepted: 09/29/2022] [Indexed: 06/16/2023]
Abstract
Very low birth weight infants (VLBW, birth weight (BW) < 1500 g) are exposed to phthalates, parabens and bisphenol A (BPA) early in life. We estimated daily intake (EDI) of these excipients in 40 VLBW infants the first and fifth week of life while hospitalised. Based on urinary samples collected in 2010, EDI was calculated and compared to the tolerable daily intake (TDI) with hazard quotients (HQs) evaluated. A HQ > 1 indicates that EDI exceeded TDI with increased risk of adverse health effects. EDI was higher in VLBW infants compared to term-born infants and older children. VLBW infants born at earlier gestational age (GA), or with lower BW, had higher EDI than infants born at later GA or with higher BW. First week median EDI for BPA was higher than TDI in 100% of infants, in 75% for di(2-ethylhexyl) phthalate (DEHP), 90% for the sum of butyl benzyl phthalate (BBzP), di-n-butyl phthalate (DnBP), DEHP and di-iso-nonyl phthalate (DiNP) = ∑BBzP+DnBP+DEHP+DiNP, and in 50% of infants for propylparaben (PrPa), indicating increased risk of adverse effects. Fifth week EDI remained higher than TDI in all infants for BPA, in 75% for DEHP and ∑BBzP+DnBP+DEHP+DiNP, and 25% of infants for PrPa, indicating prolonged risk. Maximum EDI for di-iso-butyl phthalate was higher than TDI suggesting risk of adverse effects at maximum exposure. VLBW infants born earlier than 28 weeks GA had higher EDI, above TDI, for PrPa compared to infants born later than 28 weeks GA. Infants with late-onset septicaemia (LOS) had higher EDI for DEHP, ∑BBzP+DnBP+DEHP+DiNP and BPA, above TDI, compared to infants without LOS. More 75% of the infants' EDI for DEHP and ∑BBzP+DnBP+DEHP+DiNP, 25% for PrPa, and 100% of infants' EDI for BPA, were above TDI resulting in HQs > 1, indicating increased risk of adverse health effects.
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Affiliation(s)
- Kenneth Strømmen
- Division of Paediatric and Adolescent Medicine, Department of Neonatal Intensive Care, Rikshospitalet, Oslo University Hospital, Norway.
| | - Jan Ludvig Lyche
- Department of Paraclinical Sciences, Faculty of Veterinary Medicine, Norwegian University of Life Science, Oslo, Norway
| | - Sissel Jennifer Moltu
- Division of Paediatric and Adolescent Medicine, Department of Neonatal Intensive Care, Ullevål, Oslo University Hospital, Norway
| | - Mette H B Müller
- Department of Paraclinical Sciences, Faculty of Veterinary Medicine, Norwegian University of Life Science, Oslo, Norway
| | - Elin Wahl Blakstad
- Department of Pediatric and Adolescent Medicine, Akershus University Hospital and Institute for Clinical Medicine, Campus Ahus, University of Oslo, Nordbyhagen, Norway
| | - Kristin Brække
- Division of Paediatric and Adolescent Medicine, Department of Neonatal Intensive Care, Ullevål, Oslo University Hospital, Norway
| | | | | | - Britt Nakstad
- Department of Pediatric and Adolescent Medicine, Akershus University Hospital and Institute for Clinical Medicine, Campus Ahus, University of Oslo, Nordbyhagen, Norway; Division of Paediatric and Adolescent Medicine, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway
| | - Arild Erlend Rønnestad
- Division of Paediatric and Adolescent Medicine, Department of Neonatal Intensive Care, Rikshospitalet, Oslo University Hospital, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway
| | - Christian A Drevon
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Norway
| | - Per Ole Iversen
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Norway; Department of Haematology, Oslo University Hospital, Norway
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Berisha G, Boldingh AM, Blakstad EW, Rønnestad AE, Solevåg AL. Corrigendum: Management of the unexpected difficult airway in neonatal resuscitation. Front Pediatr 2022; 10:1124050. [PMID: 36760686 PMCID: PMC9907357 DOI: 10.3389/fped.2022.1124050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 12/19/2022] [Indexed: 01/26/2023] Open
Abstract
[This corrects the article DOI: 10.3389/fped.2021.699159.].
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Affiliation(s)
- Gazmend Berisha
- Department of Paediatric and Adolescent Medicine, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Anne Marthe Boldingh
- Department of Paediatric and Adolescent Medicine, Akershus University Hospital, Lørenskog, Norway
| | - Elin Wahl Blakstad
- Department of Paediatric and Adolescent Medicine, Akershus University Hospital, Lørenskog, Norway
| | - Arild Erlend Rønnestad
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Neonatal Intensive Care, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Anne Lee Solevåg
- Department of Neonatal Intensive Care, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
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Strømmen K, Lyche JL, Moltu SJ, Müller MHB, Blakstad EW, Almaas AN, Sakhi AK, Thomsen C, Nakstad B, Rønnestad AE, Drevon CA, Iversen PO. Corrigendum to "High urinary concentrations of parabens and bisphenol A in very low birth weight infants" [Chemosphere 271 (2021) 129570]. Chemosphere 2021; 275:130613. [PMID: 33931266 DOI: 10.1016/j.chemosphere.2021.130613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Kenneth Strømmen
- Department of Neonatal Intensive Care, Division of Paediatric and Adolescent Medicine, Rikshospitalet, Oslo University Hospital, Norway; Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Norway.
| | - Jan Ludvig Lyche
- Department of Paraclinical Sciences, Faculty of Veterinary Medicine, Norwegian University of Life Science, Oslo, Norway
| | - Sissel Jennifer Moltu
- Department of Neonatal Intensive Care, Division of Paediatric and Adolescent Medicine, Ullevål, Oslo University Hospital, Norway
| | - Mette H B Müller
- Department of Paraclinical Sciences, Faculty of Veterinary Medicine, Norwegian University of Life Science, Oslo, Norway
| | - Elin Wahl Blakstad
- Department of Pediatric and Adolescent Medicine, Akershus University Hospital and Institute for Clinical Medicine, Campus Ahus, University of Oslo, Nordbyhagen, Norway
| | - Astrid Nylander Almaas
- Department of Pediatric and Adolescent Medicine, Akershus University Hospital and Institute for Clinical Medicine, Campus Ahus, University of Oslo, Nordbyhagen, Norway
| | | | | | - Britt Nakstad
- Department of Pediatric and Adolescent Medicine, Akershus University Hospital and Institute for Clinical Medicine, Campus Ahus, University of Oslo, Nordbyhagen, Norway
| | - Arild Erlend Rønnestad
- Department of Neonatal Intensive Care, Division of Paediatric and Adolescent Medicine, Rikshospitalet, Oslo University Hospital, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway
| | - Christian A Drevon
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Norway
| | - Per Ole Iversen
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Norway; Department of Haematology, Oslo University Hospital, Norway
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Strømmen K, Lyche JL, Moltu SJ, Müller MHB, Blakstad EW, Almaas AN, Sakhi AK, Thomsen C, Nakstad B, Rønnestad AE, Drevon CA, Iversen PO. High urinary concentrations of parabens and bisphenol A in very low birth weight infants. Chemosphere 2021; 271:129570. [PMID: 33453489 DOI: 10.1016/j.chemosphere.2021.129570] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 12/12/2020] [Accepted: 01/04/2021] [Indexed: 06/12/2023]
Abstract
Very low birth weight infants (VLBW; birth weight < 1500 g) are treated with pharmaceuticals and medical equipment containing parabens and bisphenol A (BPA). Parabens are used in pharmaceuticals, whereas BPA in medical equipment where concentrations are rarely reported in hospitalised VLBW infants. We measured urinary concentrations of parabens and BPA and hypothesised high and increasing concentrations in infants born at lower gestational ages (GAs), and among infants with bronchopulmonary dysplasia (BPD) and late-onset septicaemia (LOS) due to higher exposure from pharmaceuticals and medical equipment. Urinary samples were collected during the first (n = 38) and fifth (n = 36) week of life. Methylparaben, ethylparaben, propylparaben, butylparaben, and BPA concentrations were measured using ultra high-performance liquid chromatography coupled to tandem mass spectrometry. VLBW infants had very high urinary concentrations of parabens and BPA compared to term infants and older children. The Σ paraben concentration was higher than detected in previous studies on premature infants. Lower GA at birth was associated with higher concentrations of parabens and BPA. Infants born before 28 weeks GA had higher first week concentrations of propylparaben (38.6 vs. 9.05 ng/mL, p = 0.007), butylparaben (0.28 vs. 0.09 ng/mL, p = 0.05) and fifth week concentrations of BPA (15.1 vs. 6.02 ng/mL, p = 0.02) than infants born after 28 weeks GA. Infants with LOS and BPD had higher fifth week concentrations of BPA than infants without LOS and BPD (LOS: 14.2 vs. 6.77 ng/mL, p = 0.07; BPD: 18.6 vs. 7.62 ng/mL, p = 0.05).
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Affiliation(s)
- Kenneth Strømmen
- Department of Neonatal Intensive Care, Division of Paediatric and Adolescent Medicine, Rikshospitalet, Oslo University Hospital, Norway; Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Norway.
| | - Jan Ludvig Lyche
- Department of Paraclinical Sciences, Faculty of Veterinary Medicine, Norwegian University of Life Science, Oslo, Norway
| | - Sissel Jennifer Moltu
- Department of Neonatal Intensive Care, Division of Paediatric and Adolescent Medicine, Ullevål, Oslo University Hospital, Norway
| | - Mette H B Müller
- Department of Paraclinical Sciences, Faculty of Veterinary Medicine, Norwegian University of Life Science, Oslo, Norway
| | - Elin Wahl Blakstad
- Department of Pediatric and Adolescent Medicine, Akershus University Hospital and Institute for Clinical Medicine, Campus Ahus, University of Oslo, Nordbyhagen, Norway
| | - Astrid Nylander Almaas
- Department of Pediatric and Adolescent Medicine, Akershus University Hospital and Institute for Clinical Medicine, Campus Ahus, University of Oslo, Nordbyhagen, Norway
| | | | | | - Britt Nakstad
- Department of Pediatric and Adolescent Medicine, Akershus University Hospital and Institute for Clinical Medicine, Campus Ahus, University of Oslo, Nordbyhagen, Norway
| | - Arild Erlend Rønnestad
- Department of Neonatal Intensive Care, Division of Paediatric and Adolescent Medicine, Rikshospitalet, Oslo University Hospital, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway
| | - Christian A Drevon
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Norway
| | - Per Ole Iversen
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Norway; Department of Haematology, Oslo University Hospital, Norway
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Berisha G, Boldingh AM, Blakstad EW, Rønnestad AE, Solevåg AL. Management of the Unexpected Difficult Airway in Neonatal Resuscitation. Front Pediatr 2021; 9:699159. [PMID: 34778121 PMCID: PMC8589025 DOI: 10.3389/fped.2021.699159] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 09/14/2021] [Indexed: 11/13/2022] Open
Abstract
A "difficult airway situation" arises whenever face mask ventilation, laryngoscopy, endotracheal intubation, or use of supraglottic device fail to secure ventilation. As bradycardia and cardiac arrest in the neonate are usually of respiratory origin, neonatal airway management remains a critical factor. Despite this, a well-defined in-house approach to the neonatal difficult airway is often lacking. While a recent guideline from the British Pediatric Society exists, and the Scottish NHS and Advanced Resuscitation of the Newborn Infant (ARNI) airway management algorithm was recently revised, there is no Norwegian national guideline for managing the unanticipated difficult airway in the delivery room (DR) and neonatal intensive care unit (NICU). Experience from anesthesiology is that a "difficult airway algorithm," advance planning and routine practicing, prepares the resuscitation team to respond adequately to the technical and non-technical stress of a difficult airway situation. We learned from observing current approaches to advanced airway management in DR resuscitations in a university hospital and make recommendations on how the neonatal difficult airway may be managed through technical and non-technical approaches. Our recommendations mainly pertain to DR resuscitations but may be transferred to the NICU environment.
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Affiliation(s)
- Gazmend Berisha
- Department of Paediatric and Adolescent Medicine, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Anne Marthe Boldingh
- Department of Paediatric and Adolescent Medicine, Akershus University Hospital, Lørenskog, Norway
| | - Elin Wahl Blakstad
- Department of Paediatric and Adolescent Medicine, Akershus University Hospital, Lørenskog, Norway
| | - Arild Erlend Rønnestad
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Neonatal Intensive Care, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Anne Lee Solevåg
- Department of Neonatal Intensive Care, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
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Strømmen K, Lyche JL, Blakstad EW, Moltu SJ, Veierød MB, Almaas AN, Sakhi AK, Thomsen C, Nakstad B, Brække K, Rønnestad AE, Drevon CA, Iversen PO. Increased levels of phthalates in very low birth weight infants with septicemia and bronchopulmonary dysplasia. Environ Int 2016; 89-90:228-34. [PMID: 26922148 DOI: 10.1016/j.envint.2016.01.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Revised: 01/09/2016] [Accepted: 01/28/2016] [Indexed: 05/15/2023]
Abstract
Very low birth weight infants (VLBW; birth weight<1500g) are exposed to potentially harmful phthalates from medical devices during their hospital stay. We measured urinary phthalate concentrations among hospitalized VLBW infants participating in a nutritional study. Possible associations between different phthalates and birth weight (BW), septicemia and bronchopulmonary dysplasia (BPD) were evaluated. Forty-six VLBW infants were enrolled in this randomized controlled nutritional study. The intervention group (n=24) received increased quantities of energy, protein, fat, essential fatty acids and vitamin A, as compared to the control group (n=22). The concentrations of 12 urinary phthalate metabolites were measured, using high-performance liquid chromatography coupled to tandem mass spectrometry, at 3 time points during the first 5weeks of life. During this study, the levels of di (2-ethylhexyl) phthalate (DEHP) metabolites decreased, whereas an increasing trend was seen regarding metabolites of di-iso-nonyl phthalate (DiNP). Significantly higher levels of phthalate metabolites were seen in infants with lower BW and those diagnosed with late onset septicemia or BPD. A significant positive correlation between the duration of respiratory support and DEHP metabolites was observed (p≤0.01) at 2.9weeks of age. Birth weight was negatively associated with urinary phthalate metabolite concentrations. Infants with lower BW and those diagnosed with septicemia or BPD experienced prolonged exposure from medical equipment containing phthalates, with subsequent higher levels of phthalate metabolites detected. Clinical Trial Registration no.: NCT01103219.
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Affiliation(s)
- Kenneth Strømmen
- Department of Neonatal Intensive Care, Women and Children's Division, Oslo University Hospital, Rikshospitalet, Norway; Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Norway.
| | - Jan Ludvig Lyche
- Department of Food and Safety and Infection Biology, Norwegian University of Life Science, Oslo, Norway
| | - Elin Wahl Blakstad
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Norway; Department of Pediatric and Adolescent Medicine, Akershus University Hospital and Institute for Clinical Medicine, Campus Ahus, University of Oslo, Nordbyhagen, Norway
| | - Sissel Jennifer Moltu
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Norway; Department of Neonatal Intensive Care, Women and Children's Division, Oslo University Hospital, Ullevål, Norway
| | - Marit Bragelien Veierød
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Norway; Oslo Centre of Biostatistics and Epidemiology, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Norway
| | - Astrid Nylander Almaas
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Norway; Department of Pediatric and Adolescent Medicine, Akershus University Hospital and Institute for Clinical Medicine, Campus Ahus, University of Oslo, Nordbyhagen, Norway
| | - Amrit Kaur Sakhi
- Department of Exposure and Risk Assessment, Division of Environmental Medicine, Norwegian Institute of Public Health, Oslo, Norway
| | - Cathrine Thomsen
- Department of Exposure and Risk Assessment, Division of Environmental Medicine, Norwegian Institute of Public Health, Oslo, Norway
| | - Britt Nakstad
- Department of Pediatric and Adolescent Medicine, Akershus University Hospital and Institute for Clinical Medicine, Campus Ahus, University of Oslo, Nordbyhagen, Norway
| | - Kristin Brække
- Department of Neonatal Intensive Care, Women and Children's Division, Oslo University Hospital, Ullevål, Norway
| | - Arild Erlend Rønnestad
- Department of Neonatal Intensive Care, Women and Children's Division, Oslo University Hospital, Rikshospitalet, Norway
| | - Christian André Drevon
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Norway
| | - Per Ole Iversen
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Norway
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