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.”
Doula Support Improves Maternal and Child Health Outcomes, Patient and Family Engagement
In honor of World Doula Week, celebrated annually March 22-28, The National Institute for Children’s Health Quality (NICHQ) held a conversation with LaToshia Rouse, CD/PCD(DONA), owner of Birth Sisters Doula Services. Rouse currently serves as the Patient and Family Engagement Co-Chair of the National Network for Perinatal Quality Collaboratives Executive Committee and joined NICHQ’s Board of Directors in March 2022.
Supporting Indigenous Families for Improved Health Outcomes
Indigenous mothers and birthing people, fathers, partners, caregivers, and families, can speak for themselves. So, make sure seats are available – and filled – on your projects, your teams, your boards. Many projects within the MCH field have steering committees, and all should have family representation. As I hope you’ve intuited, it’s not enough to carry a message. When I think about justice, equity, diversity, and inclusion with regard to our committees, our faculty experts, or even in our improvement advisors, I have begun to ask the question: Are there people from American Indian and Alaska Native communities here?
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Look for NICHQ at 2022 American Public Health Association Annual Meeting
Join the National Institute for Children's Health Quality (NICHQ) on Nov. 6 at 2 p.m. for The Ever-Evolving Path to Equity in Children’s Health, a panel highlighting the evolution of NICHQ's equity work at the 2022 American Public Health Association Annual Meeting.
NAPPSS-IIN Hosting Community of Practice Meetings to address policies and Share Experiences about Safe Sleep and Breastfeeding
The NICHQ National Action Partnership to Promote Safe Sleep Improvement and Innovation Network (NAPPSS-IIN) project will continue to convene six Community of Practice (CoP) groups from September 2022 – March 2023. CoPs include Birthing Professionals, Community Advocacy Organizations, Community-Based Home Visitors, Early Childcare Providers, First Responders, and Researchers. Each group will convene twice to continue to address policies, improve skills, and learn from each other’s experiences in the areas of safe sleep and breastfeeding.
Racially Motivated Violence is a Children’s Health Issue
In the wake of recent mass shootings in Buffalo, Uvalde, and Highland Park, and too many others, we discuss the mental health implications of racially motivated and gun violence on children and their families with Stacy Scott, PhD, MPA, Executive Project Director and Equity Lead at NICHQ, and Becky Russell, MSPH, Senior Director of Applied Research and Evaluation at NICHQ.