The candidate is a pediatrician and neonatologist embarking on a research career focused on the study and remediation of modifiable risk factors for adverse outcome following high-risk birth, particularly the environmental determinants of abnormal neurodevelopmental outcomes. This career development award will enable her through formal coursework and expert mentorship by Drs. Philip Landrigan, Shanna Swan, and William Fifer, to develop the knowledge and skills necessary to become an independent investigator studying the impact of hospital-based chemical exposure on infant neurobehavioral development. Many industrial chemicals are known neurotoxicants in laboratory studies, but investigations of prenatal and infant exposure to these chemicals are limited, despite the fact that the developing fetus and infant are particularly susceptible to environmental insults. With this career development award, the candidate will: 1) obtain training in the methods of exposure assessment and biomarker measurements of exposure to environmental toxicants;2) obtain training in the use of infant neurobehavioral testing methods;and 3) apply the lessons learned to a research project examining biomarkers of exposure to phthalates, phenols, cadmium, and manganese and infant medical and neurobehavioral development. The training received through this career development award will enable the candidate to forge an academic trajectory in what is an under-examined area of study within the fields of neonatology and child health, with potential applications that extend to numerous aspects of pediatric healthcare. The proposed study will be the first comprehensive, longitudinal evaluation of chemical exposure in the neonatal intensive care unit (NICU) designed to evaluate clinical outcomes in this vulnerable, highly exposed population. The Research Strategy proposed is an outgrowth of the Hospital-Based Phthalate Exposure in Very Low Birth Weight Infants (HBPE) study, an ongoing, NICU-based pilot study of very low birth weight infants at the Mount Sinai Hospital. The candidate proposes to capitalize on her experience running the HBPE study and on the existing HBPE study biospecimen and data repositories to (1) identify prevalent and relevant NICU chemical exposures;(2) formalize and validate an exposure checklist to categorize patients by specific NICU exposures;and (3) conduct a comprehensive study of NICU chemical exposure and infant somatic and neurodevelopmental outcomes. The candidate plans to use the results of this study and the patient cohort amassed in Aim 3 as the basis for a future longitudinal study of childhood somatic, reproductive, and neurobehavioral outcomes in relation to hospital- based chemical exposures encountered in infancy.
Premature or otherwise sick newborns are particularly vulnerable to the effects of toxic chemicals in the environment because of their small body size, immature liver and kidney function, and rapid rate of development. As approximately 8% of neonates in the United States require admission to a neonatal intensive care unit (NICU) following birth, over 300,000 infants annually are exposed to the chemical-intensive hospital environment during this developmentally vulnerable period. In this study, the candidate will evaluate the relationship between chemical exposure in the NICU and infant medical and neurobehavioral outcomes.