Children's National Health System Posters

Title

Elevated circulating phthalate levels in pediatric pediatrics following cardiopulmonary bypass or extracorporeal membrane oxygenation procedures

Document Type

Poster

Abstract Category

Clinical Specialties

Keywords

cardiopulmonary bypass, extracorporeal membrane oxygenation, ECMO, intensive care unit, neonatal, cardiac, NICU, CICU

Publication Date

Spring 2019

Abstract

Background: Di-(2-ethylhexyl) phthalate (DEHP) is a main component of polyvinylchloride plastics used to soften otherwise rigid plastics; as such, DEHP is frequently used to manufacture plastic medical devices that are utilized in intensive care units. Cardiopulmonary bypass and extracorporeal membrane oxygenation (ECMO) are circulatory support procedures that utilize plastic tubing circuits. Although phthalates have been associated with adverse health outcomes, relatively little is known about pediatric exposure to phthalate chemicals in the clinical setting. Objective: To measure circulating phthalate levels in pediatric patients who have undergone cardiopulmonary bypass and/or ECMO procedures. Methods: Plasma samples were collected from cardiac and neonatal intensive care unit (CICU, NICU) patients over the course of their treatment, and frozen at -80C. Phthalates were isolated from plasma samples via solid phase extraction method, as described by Frederikse et al., 2010. Metabolites of DEHP (including MECCP and MEHP) were measured by mass spectrometry and the values were calculated as concentrations in parts per billion. Time points included preoperative, intraoperative, and postoperative exposure. Results: Patients included in this study underwent either cardiopulmonary bypass and/or ECMO (mixed gender, age 3 days – 2 years). The average time spent on bypass was 126.4 minutes. For plasma samples collected after CPB and ECMO, the concentration of metabolites MECCP and MEHP increased 1139 and 807%, respectively, compared with preoperative levels. Plasma samples collected 6-24hrs after the procedures resulted in MECCP and MEHP levels that were 270% and 28.4%, respectively, higher compared to preoperative levels. Conclusion Phthalate metabolites were highest in patient blood samples during procedures in which patients were exposed to plastic tubing circuits, as compared to preoperative levels. Elevated phthalate levels persisted for 6-24hours after each procedure. Further study is warranted to investigate the connection between hospital-based phthalate exposure and health outcomes.

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Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.

Open Access

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Presented at Research Days 2019.

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Elevated circulating phthalate levels in pediatric pediatrics following cardiopulmonary bypass or extracorporeal membrane oxygenation procedures

Background: Di-(2-ethylhexyl) phthalate (DEHP) is a main component of polyvinylchloride plastics used to soften otherwise rigid plastics; as such, DEHP is frequently used to manufacture plastic medical devices that are utilized in intensive care units. Cardiopulmonary bypass and extracorporeal membrane oxygenation (ECMO) are circulatory support procedures that utilize plastic tubing circuits. Although phthalates have been associated with adverse health outcomes, relatively little is known about pediatric exposure to phthalate chemicals in the clinical setting. Objective: To measure circulating phthalate levels in pediatric patients who have undergone cardiopulmonary bypass and/or ECMO procedures. Methods: Plasma samples were collected from cardiac and neonatal intensive care unit (CICU, NICU) patients over the course of their treatment, and frozen at -80C. Phthalates were isolated from plasma samples via solid phase extraction method, as described by Frederikse et al., 2010. Metabolites of DEHP (including MECCP and MEHP) were measured by mass spectrometry and the values were calculated as concentrations in parts per billion. Time points included preoperative, intraoperative, and postoperative exposure. Results: Patients included in this study underwent either cardiopulmonary bypass and/or ECMO (mixed gender, age 3 days – 2 years). The average time spent on bypass was 126.4 minutes. For plasma samples collected after CPB and ECMO, the concentration of metabolites MECCP and MEHP increased 1139 and 807%, respectively, compared with preoperative levels. Plasma samples collected 6-24hrs after the procedures resulted in MECCP and MEHP levels that were 270% and 28.4%, respectively, higher compared to preoperative levels. Conclusion Phthalate metabolites were highest in patient blood samples during procedures in which patients were exposed to plastic tubing circuits, as compared to preoperative levels. Elevated phthalate levels persisted for 6-24hours after each procedure. Further study is warranted to investigate the connection between hospital-based phthalate exposure and health outcomes.