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Abstract: PO2293

Elimination of Intravenous Phthalate Exposure Abrogates Most Neonatal Hypertension in Premature Infants

Session Information

Category: Pediatric Nephrology

  • 1700 Pediatric Nephrology

Authors

  • Farnbach, Katherine, Oregon Health and Science University, Portland, Oregon, United States
  • Forbush, Ryan, Boise State University, Boise, Idaho, United States
  • Iragorri, Sandra, Oregon Health and Science University, Portland, Oregon, United States
  • Jenkins, Randall, Oregon Health and Science University, Portland, Oregon, United States
Background

The incidence of hypertension in premature infants in a neonatal intensive care unit (NICU) was noted to transiently drop during a 2-year period when the IV fluid (IVF) temporarily changed to a phthalate-free IVF. The objective of the study is to quantify the effect of varying periods of IVF phthalate exposure on incidence of hypertension in premature infants.

Methods

A chart review was performed of all hypertensive premature infants born at one NICU during the last 6 years including a 3-year baseline period, a 20-month phthalate-free IVF period, and a 10-month period when the original phthalate-containing IVF returned to use. Patients born during 4-month transitions between periods were excluded. Incidence of hypertension for each period were compared for significant difference using Chi-Square analysis.

Results

Incidence of hypertension decreased from 9.7 cases per year (baseline) to 1.2 cases per year when IVF was phthalate-free, rising back to 12.0 cases per year when phthalate-containing IVF returned to use. Most cases met criteria for the pulmonary category of hypertension – for these infants the incidence of hypertension dropped from 7.3 to 1.2, then increased to 10.8 cases per year when evaluated for the same periods of varying phthalate exposure.

Conclusion

Serendipitous removal of IVF containing phthalates resulted in near elimination of hypertension in one NICU – an effect reversing entirely after the same brand of phthalate-containing IVF returned to clinical use. These results suggest that phthalate exposure from IVF plays a major role in neonatal hypertension, especially for those infants in the pulmonary category.

Cases of Neonatal Hypertension by etiology during three time periods, plotted with incidence of very low birthweight during the same time.
Width of each bars is scaled according to duration of the time period. Period 1: 36 months, Period 2: 20 months, Period 3: 10 months.