Exposed and Vulnerable: Sources and Health Implications of Chemical Exposures in Neonatal, Pediatric, and Cardiac Intensive Care Units

Authors

Jordan R. Kuiper, Department of Environmental and Occupational Health, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Ave NW, #2, Washington, D.C, 20037, USA. jordan.kuiper@gwu.edu.
Melania Bembea, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
J William Gaynor, Division of Cardiothoracic Surgery, Department of Surgery, Perelman School of Medicine, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA.
David Graham, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Eric M. Graham, Department of Pediatrics, Division of Cardiology, Medical University of South Carolina, Charleston, SC, USA.
Kurunthachalam Kannan, Division of Environmental Health Sciences, Wadsworth Center, New York State Department of Health, Albany, NY, USA.
Nikki G. Posnack, Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Hospital, Washington, D.C, USA.
Allen D. Everett, Division of Pediatric Cardiology, Department of Pediatrics, Johns Hopkins University, Baltimore, MD, USA.
Jessie P. Buckley, Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA.

Document Type

Journal Article

Publication Date

2-14-2025

Journal

Current environmental health reports

Volume

12

Issue

1

DOI

10.1007/s40572-025-00477-8

Keywords

NICU; PICU; Phenols; Phthalates; Plasticizers; VOCs

Abstract

PURPOSE OF REVIEW: Exposures to endocrine disrupting chemicals (EDCs) in early life have demonstrable adverse implications on child health and development. Yet, there is a dearth of studies evaluating the potential exposures to EDCs, such as bisphenols, parabens, phthalates, and volatile organic compounds (VOCs), in hospital-based settings among children who are critically ill and/or particularly vulnerable. This narrative review seeks to provide up-to-date evidence on the sources and magnitude of exposure to EDCs in neonatal-, pediatric-, and cardiac intensive care units (NICUs/PICUs/CICUs) as well as resulting health impacts. RECENT FINDINGS: Thirty-three studies were included in this review. The most frequently studied and characterized EDCs in NICUs/PICUs/CICUs were phthalates followed by terephthalates and alternative plasticizers. Evaluations of health outcomes resulting from such exposures were scarce, and few studies assessed health outcomes after hospital discharge. EDCs are pervasive in NICU/PICU/CICU settings and pediatric exposure levels are much higher than in other environments. However, the existing evidence has multiple limitations that should be addressed in future work. Specifically, studies evaluating a more expansive array of chemicals, including contemporary and emerging replacements for legacy compounds, are needed, as are studies that consider chemical mixtures. Additionally, few studies evaluated the health impacts of chemical exposures, and their mixtures, in NICU/PICU/CICU settings, especially long-term health outcomes observed after hospital discharge. Such studies could be invaluable in supporting policy as well as development of medical products without toxic chemicals.

APA Citation

Kuiper, Jordan R.; Bembea, Melania; Gaynor, J William; Graham, David; Graham, Eric M.; Kannan, Kurunthachalam; Posnack, Nikki G.; Everett, Allen D.; and Buckley, Jessie P., "Exposed and Vulnerable: Sources and Health Implications of Chemical Exposures in Neonatal, Pediatric, and Cardiac Intensive Care Units" (2025). GW Authored Works. Paper 6576.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/6576

Department

Environmental and Occupational Health