203. Peri-operative Exposure to Volatile Organic Compounds in Neonates Undergoing Cardiac Surgery
Presented During: Precision Medicine in Congenital Heart Disease*
The Childrens Hospital of Philadelphia
Philadelphia, PA
United States - Contact Me
Attending surgeon at the Children's Hospital of Philadelphia
Monday, May 8, 2023: 7:45 AM - 8:00 AM
15 Minutes
Los Angeles Convention Center
Room: 403B
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.
Presentation Duration
7 minute presentation; 7 minute discussion