Improving Healthcare Environments for Vulnerable Newborns
Neonatal Intensive Care Units (NICUs) provide life-saving care for preterm babies. But, as with any urgent, intensive healthcare treatment, there is also the possibility for adverse long-term health concerns. One of the newest concerns for NICU babies is exposure to chemicals that can be hazardous to their health, specifically phthalates, a chemical softener for plastics.
Most U.S. children are exposed to phthalates through common every day sources, such as plastics in food packaging and toys. But NICU babies can be exposed to a higher level of phthalates at an especially vulnerable period of life. Now, the Icahn School of Medicine at Mount Sinai (ISMMS) and the Albert Einstein College of Medicine are leading a new study on phthalates exposure in the NICU.
“Phthalates are pervasive in the medical equipment used in the NICU,” explains Susan Teitelbaum, PhD, from ISMMS. “Exposure to phthalates, both in utero and in early childhood, has been associated with poor health outcomes, including respiratory illness, obesity and neurodevelopmental delays in children who were born full-term.”
The impact of phthalate exposure on the more than 300,000 premature babies admitted to the NICU every year—babies who are already at risk for cognitive delays, lung infections, and digestive disorders due to their early birth—is completely unknown.
“No one has investigated how the chemically intensive environment of the NICU may contribute to or exacerbate the health problems that are common among preterm infants, or how it may affect their long-term health,” says Judy Aschner, MD, from Einstein.
This is especially concerning given that the brain is going through a critical period of development during a premature baby’s first weeks of life. Adverse environmental experiences during this period of rapid cognitive programming may have life-long consequences.
Phthalates are not the only environmental exposure in the NICU that requires further study, Aschner adds. “Babies may also be exposed to metals in the NICU. We sometimes find traces of lead and aluminum in intravenous solutions or even in our blood supplies. Understanding the long-term effects of these exposures can help improve NICU environments.”
An unprecedented opportunity for change
To improve healthcare environments for these vulnerable newborns, Einstein and ISMMS are leading a first-of-its-kind study on the long-term impact of environmental exposures in the NICU: Environmental Influences on Child Health Outcomes: Developmental Impact of NICU Exposures (ECHO DINE). ECHO DINE is part of the ECHO Program, a seven-year initiative seeking to answer crucial questions about the effects of a broad range of early environmental influences on child health and development.
Specifically, the ECHO DINE study seeks to:
- Identify sources of phthalate exposures in preterm babies admitted to the NICU by studying urine samples collected from NICU babies. Analyzing each baby’s exposure alongside their length of stay and what medical equipment they encountered can help isolate the sources of exposure.
- Measure the impact of NICU-based phthalate exposure on health outcomes for those children. The urine samples used by ECHO DINE were collected in a previous study from children who are now ages 3 to 7. Parents of these children are completing surveys and physical assessments about their children on a variety of health indicators—including cognitive function, motor and communication skills, growth measurements, weight, height, social behaviors— that can help illustrate the long-term impacts of their original phthalate exposure.
NICHQ is tapping its project management and data analysis expertise to support the study, including collaborating with Einstein and ISMMS to develop data measures and working with the clinical sites to support data collection efforts.
Studying each child’s exposure alongside his or her health trajectory can illustrate how adverse environmental exposures in the NICU affect long-term health outcomes. These findings have the potential to change care practices and policies in the NICU.
“While there are rules about how much phthalates can go into children’s toys, phthalates in medical devices are not regulated at all,” says Aschner. “Every company does something different and there may be some phthalate mixtures that are more or less risky to a developing human being. By tracing adverse effects directly to their source, we can identify what plastics and specific equipment are linked with high phthalate exposure—that’s the importance of this study.”
The findings from the study also have the potential to help better identify health risks for babies who do reach term but are exposed to phthalates during pregnancy. Up until now, explains Teitelbaum, studies on the effects of this exposure have been limited.
Findings from the DINE study will join findings from the full ECHO Program, which encompasses studies on more than 50,000 children. Together, these research projects will help provide a more complete picture of how the environment influences children’s health outcomes at many different windows of susceptibility, from the prenatal period through adolescence.
“It’s gratifying to be part of what is truly groundbreaking work,” says NICHQ Senior Analyst Emily O’Donnell, ScD, MS. “The fact that we are collecting data points across such a diverse set of measures, over this extended time period, offers a really powerful and unique data set with which we can explore the research aims.”
North Carolina’s Strategy to Address Social Determinants of Health
North Carolina is developing a system that connects individuals with resources to address social, economic and environmental barriers to their health—such as housing, food insecurity, and transportation. By putting funding and policy efforts into addressing social determinants of health, North Carolina is building a system that can improve health outcomes for children and families across the state.
NICHQ Employee Spotlight: Colleen Bernard
In honor or our 20th anniversary, we're sharing insights, memories and goals from the NICHQ team. Here, NICHQ Project Specialist Colleen Bernard shares her proudest moment during her time at NICHQ and her goals for NICHQ's future.
Breastfeeding in 2019: Safe Sleep, Bias, Gender Equitable Norms, and Paid Leave
In honor of National Breastfeeding Month, we’ve taken time with NICHQ Faculty Expert, Lori Feldman-Winter, MD, MPH, an internationally and nationally recognized expert on breastfeeding nutrition, education and policy, to recognize successes and learn about opportunities for improvement. Her frank description of bias and her passion for promoting gender-equitable social norms have inspired us to continue pursuing sustainable improvements.
Successful Strategies Hospitals Can Use to Support Safe Sleep
Hospitals on a national initiative to improve safe sleep came together to share successes and lessons-learned. Here, find their highest-rated strategies and change ideas, all of which reflect early successes in their work. Hospitals seeking to improve safe sleep education can refer to this list as a place to start and guide for gaining quick wins.
Improving Transitions in Care Saves Lives
Advancements in care have helped more children with rare diseases reach adulthood, but health systems and providers have struggled to help children transition to adult care, resulting in high rates of complications and mortality for young adults. These strategies for helping young adults with sickle cell disease transition to adult care can save lives.
“The Act of Making a Referral is Not Enough”
Universal developmental screenings can help identify children at risk for developmental delays and connect them with needed supports. An effective screening process relies on successful referrals though—if there is no follow-up with the referred child, families can never access the supports the child may need, and that child may ultimately fall through the cracks. Here, Dipesh Navsaria, MPH, MSLIS, MD, Associate Professor of Pediatrics at the University of Wisconsin School of Medicine and Public Health provides five steps to build a referral process that works.