Exposure of preterm neonates to toxic metals during their stay in the Neonatal Intensive Care Unit and its impact on neurodevelopment at 2 months of age |
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| Institution: | 1. Environmental Health Program, King Faisal Specialist Hospital and Research Centre, P.O. Box: 3354, Riyadh 11211, Saudi Arabia;2. Center for Autism Research, King Faisal Specialist Hospital and Research Centre, P.O. Box: 3354, Riyadh 11211, Saudi Arabia;3. Neonatal Critical Care Section, Department of Pediatrics, King Faisal Specialist Hospital and Research Centre, P.O. Box: 3354, Riyadh 11211, Saudi Arabia;1. Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, PO Box 38, 11129 Belgrade, Serbia;2. Institute of Pathology, Faculty of Medicine, University of Belgrade, Dr. Subotica 1, 11000 Belgrade, Serbia;1. Center for Reproductive Medicine, Department of Obstetrics and Gynaecology, NanFang Hospital, Southern Medical University, Guangzhou, Guangdong, China;2. The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China;3. Assisted Reproductive Technology Unit, Department of Obstetrics and Gynaecology, Faculty of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong;1. Department of Obstetrics and Gynaecology, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, China;2. Department of Science and Education, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, China;1. Department of Social Medicine, Graduate School of Medicine, Hirosaki University, Japan;2. School of Medicine, Hirosaki University, Japan;3. Department of Hematology, National Cancer Center Hospital, Japan;4. Center of Innovation, Research Initiatives Organization, Hirosaki University, Japan;1. Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Morgantown, WV, 26505, USA;2. Former Affiliate of Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Morgantown, WV, 26505, USA;3. 4299 Mount Horeb Pike, Lexington, KY, 40511, USA;4. Department of Public Health Sciences, University of California, Davis, CA, 95616, USA |
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| Abstract: | BackgroundPremature neonates might be exposed to toxic metals during their stay in the neonatal intensive care unit (NICU), which could adversely affect neurodevelopment; however, limited evidence is available. The present study was therefore designed to assess the exposure to mercury, lead, cadmium, arsenic, and manganese of preterm neonates who received total parenteral nutrition (TPN) and/or red blood cell (RBC) transfusions during their NICU stay and the risk of neurodevelopment delay at the age of 2 months.MethodsWe recruited 33 preterm neonates who required TPN during their NICU admission. Blood samples were collected for metal analysis at two different time points (admission and before discharge). Metals in the daily TPN received by preterm neonates were analyzed. Neurodevelopment was assessed using the Ages and Stages Questionnaire Edition 3 (ASQ-3).ResultsAll samples of TPN had metal contamination: 96% exceeded the critical arsenic limit (0.3 μg/kg body weight/day); daily manganese intake from TPN for preterm neonates exceeded the recommended dose (1 µg/kg body weight) as it was added intentionally to TPN solutions, raising potential safety concerns. All samples of RBC transfusions exceeded the estimated intravenous reference dose for lead (0.19 µg/kg body weight). Levels of mercury, lead and manganese in preterm neonates at discharge decreased 0.867 µg/L (95% CI, 0.76, 0.988), 0.831 (95%CI, 0.779, 0.886) and 0.847 µg/L (95% CI, 0.775, 0.926), respectively. A decrease in ASQ-3-problem solving scores was associated with higher levels of blood lead in preterm neonates taken at admission (ß = ?0.405, 95%CI = ?0.655, ?0.014), and with plasma manganese (ß = ?0.562, 95%CI = ?0.995, ?0.172). We also observed an association between decreased personal social domain scores with higher blood lead levels of preterm neonates before discharge (ß = ?0.537, 95%CI = ?0.905, ?0.045).ConclusionOur findings provide evidence to suggest negative impacts on the neurodevelopment at 2 months of preterm infants exposed to certain metals, possibly related to TPN intake and/or blood transfusions received during their NICU stay. Preterm neonates may be exposed to levels of metals in utero. |
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| Keywords: | Mercury Lead Cadmium Arsenic Manganese Neurodevelopment Blood transfusion Total parenteral nutrition NICU |
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