BREASTFEEDING MAY EXPOSE INFANTS TO TOXIC CHEMICALS

A widely used class of industrial chemicals linked with cancer and interference with immune function--perfluorinated alkylate substances, or PFASs--appears to build up in infants by 20%-30% for each month they're breastfed, according to a new study co-authored by experts from Harvard T.H. Chan School of Public Health. It is the first study to show the extent to which PFASs are transferred to babies through breast milk, and to quantify their levels over time.

 "We knew that small amounts of PFAS can occur in breast milk, but our serial blood analyses now show a buildup in the infants, the longer they are breastfed," said Philippe Grandjean, adjunct professor of environmental health at Harvard Chan School.

The study appeared online August 20, 2015 in Environmental Science & Technology. Other study authors were from Danish universities and the Faroese Hospital System.

PFASs are used to make products resistant to water, grease, and stains. They've been in use for more than 60 years in products such as stain-proof textiles, waterproof clothing, some food packaging, paints, and lubricants, and are known to contaminate drinking water in the U.S. near various production facilities. These compounds--which tend to bioaccumulate in food chains and can persist for a long time in the body--are found regularly in the blood of animals and humans worldwide, and have been linked with reproductive toxicity, endocrine disruption, and immune system dysfunction.

The researchers followed 81 children who were born in the Faroe Islands between 1997-2000, looking at levels of five types of PFASs in their blood at birth and ages 11 months, 18 months, and 5 years. They also looked at PFAS levels in mothers of the children at week 32 of pregnancy.

They found that, in children who were exclusively breastfed, PFAS concentrations in the blood increased by roughly 20%-30% each month, with lower increases among children who were partially breastfed. In some cases, by the end of breastfeeding, children's serum concentration levels of PFASs exceeded that of their mothers'.

One type of PFAS--perfluorohexanesulfonate--did not increase with breastfeeding. After breastfeeding was stopped, concentrations of all of five types of PFASs decreased.

The results suggest that breast milk is a major source of PFAS exposure during infancy.

"There is no reason to discourage breastfeeding, but we are concerned that these pollutants are transferred to the next generation at a very vulnerable age. Unfortunately, the current U.S. legislation does not require any testing of chemical substances like PFASs for their transfer to babies and any related adverse effects," Grandjean said.

Funding for the study came from the National Institute of Environmental Health Sciences, NIH (ES012199); the U.S. Environmental Protection Agency (R830758); the Danish Council for Strategic Research (09-063094); and the Danish Environmental Protection Agency as part of the environmental support program DANCEA (Danish Cooperation for Environment in the Arctic).

PREMATURE INFANTS ARE EXPOSED TO UNSAFE LEVELS OF CHEMICAL IN MEDICAL PRODUCTS USED TO DAVE THEIR LIVES

Hospitalized premature infants are exposed to unsafe levels of a chemical found in numerous medical products used to treat them, raising questions about whether critically ill newborns may be adversely affected by equipment designed to help save their lives.

The chemical, di(2-ethylhexyl)phthalate (DEHP), is used to increase flexibility of many plastic devices. These products, made from polyvinyl chloride (PVC), include most intravenous tubing, catheters, endotracheal tubes, and fluid and blood product bags. DEHP doesn't bind chemically to PVC, and is able to leach into fluids and body tissues in contact with it. New Johns Hopkins Bloomberg School of Public Health research suggests that critically ill preterm infants may be exposed to DEHP at levels approximately 4,000 to 160,000 times higher than those believed to be safe. Infants can receive high exposures to DEHP during weeks to months of treatment in a hospital's neonatal intensive care unit (NICU).

The results are reported online Nov. 13 date by the Journal of Perinatology.

"It's remarkable that the care of sick and developmentally vulnerable preterm infants depends on an environment composed almost entirely of plastic," says neonatologist Eric B. Mallow, MD, MPH, a senior research program coordinator at the Bloomberg School and the study's leader. "The role of these synthetic materials in the clinical course of our patients remains almost completely unexplored. PVC is the predominant flexible plastic in most NICUs, and this can result in considerable DEHP exposures during intensive care."

Mallow and co-investigator Mary A. Fox, PhD, MPH, an assistant professor in the Department of Health Policy and Management, reviewed and analyzed previously published studies of DEHP and its potential risks. Nearly all public attention to the health effects of phthalates, for both the general population and hospitalized patients, has focused on their role as endocrine disruptors -- substances that can interfere with normal hormone function.

However, the researchers found abundant published evidence that DEHP has a wide range of non-endocrine toxic effects, and they propose that these could affect the short- and long-term health of NICU patients. DEHP has been shown repeatedly in animal studies to increase inflammation, cause liver injury, and interfere with development of lung, brain, and eye. Clinical studies confirm that some of these effects occur in NICU patients as well.

"We were floored by how high the exposures are when you look at all of the devices together," Fox says. "It's a population that we know is vulnerable to begin with. They're struggling to survive. And the concern now is whether this phthalate exposure is actually contributing to their problems when these medical products are supposed to be helping them get better."

Phthalates, including DEHP, are found in a wide range of consumer products, such as food packaging, clothing, upholstery, vinyl flooring, cosmetics, and fragrances. DEHP is the only phthalate approved for medical devices in the U.S., and its use is unregulated. In contrast, DEHP and several other phthalates are limited to trace amounts in children's toys and childcare products.

The new research finds that the total daily exposure for a two-kilogram (four-pound) critically ill infant can reach 16 mg/kg per day. The largest sources are blood products, and endotracheal tubes placed in the airway to deliver breathing support with a ventilator. In analyzing toxic thresholds, the researchers determined that daily DEHP intakes are approximately 4,000 times higher than desired to prevent a type of male reproductive toxicity, and 160,000 times higher than desired to prevent liver injury. They say that a lower DEHP exposure could be one reason why preemies who can be managed without a ventilator seem to have better lung outcomes.

The researchers say that replacing DEHP-containing products in the NICU with existing alternative products that don't contain DEHP would be the most effective initial step in reducing phthalate exposures during critical care. Further reductions could be attained by addressing other sources of phthalates in the NICU, including construction materials (such as vinyl flooring and paints); equipment such as ventilators and incubators; soaps, lotions and other cosmetics used by staff and visitors; and even the soaps, lotions and powders used for baby care.

"We do have to make tradeoffs and we want to save these babies," Fox says. "But can we save them by using alternative products that reduce their exposures to substances that may be harming them? It seems like we could."

MOTHERS SOOTHING PRESENCE MAKES PAIN GO AWAY CHANGES GENE ACTIVITY IN INFANTS BRAIN

A mother's "TLC" not only can help soothe pain in infants, but it may also impact early brain development by altering gene activity in a part of the brain involved in emotions, according to new study from NYU Langone Medical Center.

By carefully analyzing what genes were active in infant rat brains when the mother was present or not present, the NYU researchers found that several hundred genes were more, or less, active in rat infants experiencing pain than in those that were not. With their mothers present, however, fewer than 100 genes were similarly expressed.

According to senior study investigator and neurobiologist Regina Sullivan, PhD, who is scheduled to present her team's findings at the Society for Neuroscience annual meeting in Washington, D.C., on Nov. 18, the research is believed to be the first to show the short-term effects of maternal caregiving in a distressed infant pup's brain. The study was also designed to support her research into the long-term consequences of differences in how mammals, including humans, are nurtured from birth.

"Our study shows that a mother comforting her infant in pain does not just elicit a behavioral response, but also the comforting itself modifies -- for better or worse -- critical neural circuitry during early brain development," says Sullivan, a professor at the NYU School of Medicine and its affiliated Nathan S. Kline Institute for Psychiatric Research.

For the study, researchers performed genetic analyses on tissue from the almond-sized amygdala region of the infant rat pups' brains that is responsible for processing emotions, such as fear and pleasure.

Sullivan, whose earlier research showed how the mother's presence controlled electrical signaling in the infant pup's brain, says her latest findings shed insight on the complexity of treating pain in newborns.

"Nobody wants to see an infant suffer, in rats or any other species," says Sullivan. "But if opiate drugs are too dangerous to use in human infants because of their addictive properties, then the challenge remains for researchers to find alternative environmental stimuli, including maternal presence, coddling, or other cues, such as a mother's scent, that could relieve the pain."

Sullivan cautions, however, that the long-term consequences of these genetic modifications must also be compared to the short-term benefits for tying pain stimuli during infancy to such a powerful symbol of safety and security as the infant's mother.

"The more we learn about nurturing the infant brain during infancy, the better prepared we are to deal long-term with treating problems that arise from pain, and physical and mental abuse experienced during infancy," says Sullivan.