Peri-operative Exposure to Volatile Organic Compounds in Neonates Undergoing Cardiac Surgery
Presented During:
Monday, May 8, 2023: 7:45AM - 8:00AM
Los Angeles Convention Center
Posted Room Name:
403B
Abstract No:
203
Submission Type:
Abstract Submission
Authors:
J. William Gaynor (1), Eric M. Graham (2), Deepak Bhandari (3), Matthew Fenchel (4), Asa Bradman (5), Brenna Klepczynski (6), Richard F. Ittenbach (4), Christopher M. Reese (3), Benjamin C. Blount (3)
Institutions:
(1) The Children's Hospital Of Philadelphia, Philadelphia, PA, (2) MUSC, Charleston, SC, (3) CDC, Atlanta, GA, (4) Cincinnati Children's Hospital Medical Center, Cincinnati, OH, (5) University of California Merced, Merced, CA, (6) CHOP, Philadelphia, PA
Submitting Author:
*J. William Gaynor
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The Children's Hospital Of Philadelphia
The Children's Hospital Of Philadelphia
Co-Author(s):
Eric M. Graham
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MUSC
MUSC
Deepak Bhandari
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CDC
CDC
Matthew Fenchel
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Cincinnati Children's Hospital Medical Center
Cincinnati Children's Hospital Medical Center
Asa Bradman
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University of California Merced
University of California Merced
Brenna Klepczynski
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CHOP
CHOP
Richard F. Ittenbach
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Cincinnati Children's Hospital Medical Center
Cincinnati Children's Hospital Medical Center
Christopher M. Reese
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CDC
CDC
Benjamin C. Blount
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CDC
CDC
Presenting Author:
*J. William Gaynor
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The Children's Hospital Of Philadelphia
The Children's Hospital Of Philadelphia
Abstract:
Objective: Volatile organic compounds (VOCs) are used in the sterilization and manufacture of medical equipment. VOCs have high vapor pressures and low water solubility and are emitted as gases from solids or liquids. VOCs can be mutagenic, neurotoxic, genotoxic, and/or carcinogenic. Safe limits of exposure for many VOCs are not known for neonates. This study examined determinants of VOC exposure in newborns undergoing cardiac surgery.
Methods: Nineteen metabolites of 16 VOCs (e.g., xylene, cyanide, acrolein, acrylonitrile, N, N-dimethylformamide, 1,3-butadiene, styrene, and benzene; see Table) were measured as metabolites in daily urine samples collected during the perioperative period from 10 neonates undergoing cardiac operations over 10 days (n=100 samples). VOC metabolites were quantified using reversed-phase ultra-high performance liquid chromatography and electrospray ionization tandem mass spectrometry. Repeated measures ANOVA was performed for each VOC and some commonly used medical devices. The magnitude of exposure was compared to the National Health and Nutrition Examination Survey (NHANES) observations in 3–5-year-old children.
Results: Five or more VOC metabolites were detected in every sample [measured value > limit of detection (LOD)]. The median number of metabolites in each sample > LOD was 14 (range: 5-15). In a model controlling for other factors, the use of extracorporeal membrane oxygenation (ECMO) was associated with significantly (p≤0.05) higher metabolite levels of acrolein, acrylonitrile, ethylene oxide, propylene oxide, styrene, and ethylbenzene. Non-intubated patients had higher levels of 2-aminothiazoline-4-carboxylic acid, a metabolite of cyanide suggesting exposure from the ambient air (p=0.023). Compared to NHANES, daily levels frequently were > 75th percentile for the following analytes: N-acetyl-S-(benzyl)-L-cysteine (63 of 100 samples), N-acetyl-S-(2-cyanoethyl)-L-cysteine (47 of 100 samples), and N-acetyl-S-(2-hydroxyethyl)-L-cysteine (87 of 100 samples).
Conclusions: VOC exposure in newborns undergoing cardiac surgery is pervasive. Sources of exposure likely include medical devices (ECMO) and inhalation from the air in the intensive care unit. The safe levels of VOC exposure in neonates are unknown. The magnitude of exposure to some VOCs is greater than the reference population. The contribution of VOC exposure during cardiac surgery in newborns to adverse outcomes warrants further evaluation.
Methods: Nineteen metabolites of 16 VOCs (e.g., xylene, cyanide, acrolein, acrylonitrile, N, N-dimethylformamide, 1,3-butadiene, styrene, and benzene; see Table) were measured as metabolites in daily urine samples collected during the perioperative period from 10 neonates undergoing cardiac operations over 10 days (n=100 samples). VOC metabolites were quantified using reversed-phase ultra-high performance liquid chromatography and electrospray ionization tandem mass spectrometry. Repeated measures ANOVA was performed for each VOC and some commonly used medical devices. The magnitude of exposure was compared to the National Health and Nutrition Examination Survey (NHANES) observations in 3–5-year-old children.
Results: Five or more VOC metabolites were detected in every sample [measured value > limit of detection (LOD)]. The median number of metabolites in each sample > LOD was 14 (range: 5-15). In a model controlling for other factors, the use of extracorporeal membrane oxygenation (ECMO) was associated with significantly (p≤0.05) higher metabolite levels of acrolein, acrylonitrile, ethylene oxide, propylene oxide, styrene, and ethylbenzene. Non-intubated patients had higher levels of 2-aminothiazoline-4-carboxylic acid, a metabolite of cyanide suggesting exposure from the ambient air (p=0.023). Compared to NHANES, daily levels frequently were > 75th percentile for the following analytes: N-acetyl-S-(benzyl)-L-cysteine (63 of 100 samples), N-acetyl-S-(2-cyanoethyl)-L-cysteine (47 of 100 samples), and N-acetyl-S-(2-hydroxyethyl)-L-cysteine (87 of 100 samples).
Conclusions: VOC exposure in newborns undergoing cardiac surgery is pervasive. Sources of exposure likely include medical devices (ECMO) and inhalation from the air in the intensive care unit. The safe levels of VOC exposure in neonates are unknown. The magnitude of exposure to some VOCs is greater than the reference population. The contribution of VOC exposure during cardiac surgery in newborns to adverse outcomes warrants further evaluation.
CONGENTIAL:
Neonatal and Pediatric Cardiac Surgery
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