Neonatal exposure to phthalate and alternative plasticizers via parenteral nutrition

In vitro digestion of microplastics in human digestive system: Insights into particle morphological changes and chemical leaching

Despite the well-reported occurrences and established pathways for microplastics (MPs) ingestion by humans, the eventual fate of these particles in the human gastrointestinal system is poorly understood. The present study tries to gain a better understanding of the fate of four common food-borne MPs, i.e. Polystyrene (PS), Polypropylene (PP), Low-density Polyethylene (LDPE), and Nylon, in a simulated in vitro human digestive system. Firstly, the changes in the physicochemical properties of 20-210 μm sized MPs as well as the leaching of chemicals were monitored using fluorescence microscopy, FTIR, and LC-QTOF-MS. Thereafter, the mass loss and morphological alterations in 3-4 mm sized MPs were observed after removing the organic matter. The interaction of PS and PP MPs with duodenal and bile juices manifested in a corona formation. The increase in surface roughness in PP MPs aligned with MP-enzyme dehydrogenation reactions and the addition of NO groups. A few fragments ranging from 30 to 250 μm, with negligible mass loss, were released during the MP digestion process. In addition, the leaching of compounds, e.g. capsi-amide, butanamide, and other plasticizers and monomers was also observed from MPs during digestion, and which may have the potential to accumulate and get absorbed by the digestive organs, and to subsequently impart toxic effects.

Ongoing exposure to endocrine disrupting phthalates and alternative plasticizers in neonatal intensive care unit patients

Due to endocrine disrupting effects, di-(2-ethylhexyl) phthalate (DEHP), a plasticizer used to soften plastic medical devices, was restricted in the EU Medical Devices Regulation (EU MDR 2017/745) and gradually replaced by alternative plasticizers. Neonates hospitalized in the neonatal intensive care unit (NICU) are vulnerable to toxic effects of plasticizers. From June 2020 to August 2022, urine samples (n = 1070) were repeatedly collected from premature neonates (n = 132, 4-10 samples per patient) born at <31 weeks gestational age and/or <1500 g birth weight in the Antwerp University Hospital, Belgium. Term control neonates (n = 21, 1 sample per patient) were included from the maternity ward. Phthalate and alternative plasticizers' metabolites were analyzed using liquid-chromatography coupled to tandem mass spectrometry. Phthalate metabolites were detected in almost all urine samples. Metabolites of alternative plasticizers, di-(2-ethylhexyl)-adipate (DEHA), di-(2-ethylhexyl)-terephthalate (DEHT) and cyclohexane-1,2-dicarboxylic-di-isononyl-ester (DINCH), had detection frequencies ranging 30-95 %. Urinary phthalate metabolite concentrations were significantly higher in premature compared to control neonates (p = 0.023). NICU exposure to respiratory support devices and blood products showed increased phthalate metabolite concentrations (p < 0.001). Phthalate exposure increased from birth until four weeks postnatally. The estimated phthalate intake exceeded animal-derived no-effect-levels (DNEL) in 10 % of samples, with maximum values reaching 24 times the DNEL. 29 % of premature neonates had at least once an estimated phthalate intake above the DNEL. Preterm neonates are still exposed to phthalates during NICU stay, despite the EU Medical Devices Regulation. NICU exposure to alternative plasticizers is increasing, though currently not regulated, with insufficient knowledge on their hazard profile.

Common Clinical Scenarios of Systemic Hypertension in the NICU

Hypertension affects ∼1% to 3% of newborns in the NICU. However, the identification and management of hypertension can be challenging because of the lack of data-driven diagnostic criteria and management guidelines. In this review, we summarize the most recent approaches to diagnosis, evaluation, and treatment of hypertension in neonates and infants. We also identify common clinical conditions in neonates in whom hypertension occurs, such as renal vascular and parenchymal disease, bronchopulmonary dysplasia, and cardiac conditions, and address specific considerations for the evaluation and treatment of hypertension in those conditions. Finally, we discuss the importance of ongoing monitoring and long-term follow-up of infants diagnosed with hypertension.