Presence of Bisphenol A and Parabens in a Neonatal Intensive Care Unit: An Exploratory Study of Potential Sources of Exposure

Abstract

Background:Newborns in neonatal intensive care units (NICUs) are in contact with a variety of medical products whose production might include synthetic chemicals with hormonal activity.Objectives:Our aim was to assess the content of bisphenol A (BPA) and parabens (PBs) and the hormone-like activities of a subset of medical products commonly used in NICUs in prolonged intimate contact with NICU newborns.Methods:Fifty-two NICU items were analyzed, determining the concentrations of BPA and PBs [methyl- (MeP), ethyl- (EtP), propyl- (PrP), and butylparaben (BuP)] and using the E-Screen and PALM-luciferase assays to measure the in vitro (anti-)estrogenic and (anti-)androgenic activity, respectively, of the extracts. Items found to have elevated BPA/PB content or hormone-like activities were further extracted using leaching methodologies.Results:BPA was found in three-fifths and PBs in four-fifths of tested NICU items, and ∼25% and ∼10% of extracts evidenced estrogenic and anti-androgenic activity, respectively. The highest BPA content was found in the three-way stopcock (>7.000 ng/g), followed by patterned transparent film dressing, gastro-duodenal feeding tubes, sterile gloves, single-lumen umbilical catheters, and intravenous (IV) infusion extension sets (concentrations ranged from 100 to 700 ng/g BPA). A total PB concentration (∑PBs) >100 ng/g was observed in several items, including light therapy protection glasses, patterned transparent film dressing, winged IV catheters, IV infusion extension sets, and textile tape. The highest estrogenic activity [>450 pM estradiol equivalent (normalE2eq)] was found in small dummy nipples, three-way stopcocks, and patterned transparent film dressing and the highest anti-androgenic activity [>5 mM procymidone equivalent units per gram (Proceq/g)] in small dummy nipples and three-way stopcocks.Discussion:According to these findings, neonates might be exposed to multiple sources of BPA and PBs in NICUs via inhalation, dermal, oral, and IV/parenteral routes. There is a need to address the future health implications for these extremely vulnerable patients and to adopt precautionary preventive measures as a matter of urgency. https://doi.org/10.1289/EHP5564

Bisphenols and phthalates: Plastic chemical exposures can contribute to adverse cardiovascular health outcomes

“…While environmental exposure to BPA is continuous at a relatively low dose (Koch & Calafat, 2009; Vandenberg et al, 2007, 2010)—clinical (Calafat et al, 2009; Duty et al, 2013; Gaynor et al, 2018) and occupational (C. J. Hines et al, 2018; Ribeiro, Ladeira, & Viegas, 2017) environments can result in higher BPA exposures (Table 1) (Calafat et al, 2009; Duty et al, 2013; Gaynor et al, 2018; Huygh et al, 2015). BPA has been detected in 60% of neonatal intensive care unit (ICU) supplies, and experimental studies have identified estrogenic activity in >25% of extracts from these items (Iribarne‐Durán et al, 2019). Clinical exposure can result in heightened and/or prolonged exposure to BPA, particularly in neonatal and pediatric patients with an underdeveloped metabolic system (Calafat et al, 2009).…”

Unwitting Accomplices: Endocrine Disruptors Confounding Clinical Care

“…Urinary BPA levels were also elevated in NICU babies exposed to phthalate-containing products, illustrating the challenge of combinatorial EDC exposures in the critical care setting ( 25 ). In a recent analysis of 52 common NICU items, the authors found that three-fifths of equipment contained BPA and fourth-fifths contained parabens ( 26 ). Critically, this study also demonstrated that extracts from the medical supplies altered endocrine activity in cell lines, with 25% of the extracts demonstrating estrogenic activity and 10% showing anti-androgenic activity ( 26 ).…”

“…In a recent analysis of 52 common NICU items, the authors found that three-fifths of equipment contained BPA and fourth-fifths contained parabens ( 26 ). Critically, this study also demonstrated that extracts from the medical supplies altered endocrine activity in cell lines, with 25% of the extracts demonstrating estrogenic activity and 10% showing anti-androgenic activity ( 26 ). Given the critical organizational role of hormones during development, these endocrine-disrupting activities raise concerns about long-term health risks.…”

Bisphenol S and bisphenol F are less disruptive to cardiac electrophysiology and potentially safer for use in medical products, as compared to bisphenol A

“…Although environmental exposure to BPA occurs at a relatively low dose (Koch and Calafat 2009; Vandenberg et al 2007, 2010), occupational (Hines et al 2018; Ribeiro et al 2017) and clinical environments can result in exceedingly high BPA exposure (Calafat et al 2009; Duty et al 2013; Gaynor et al 2018; Huygh et al 2015; Testai et al 2016). Indeed, BPA was detected in 60% of neonatal intensive care unit (NICU) supplies, including items used for feeding, bandages, breathing support, intravenous and parenteral infusion (Iribarne-Durán et al 2019). Clinical exposure can also result in heightened and/or prolonged BPA exposure in young patients, due to an underdeveloped metabolic system (Calafat et al 2009).…”