Çocuk Yoğun Bakım Hastalarında Kullanılan Tıbbi Malzemelerin İdrar Bisfenol A Düzeylerine Etkisi

Abstract

The exposure of pediatric intensive care patients to Bisphenol A may be different in acute sick children who were healthy beforehand, and chronically sick children, due to the use of multiple and various medical materials. This research aims to evaluate urinary total BPA (tBPA) levels and association with medical devices used on patients in pediatric intensive care units. This cross-sectional descriptive study included 117 critically ill children who were hospitalized in our pediatric intensive care unit. At least two or three urine samples (on the first day of intensive care, seven days later, and 30 days later or at discharge) were obtained from the patients. A patient form was created for each participant and all of the materials used (peripheral or central infusion catheters, infusion bags, total parenteral nutrition, nasogastric tube, intubation tube, tracheostomy cannula, chest tube, extraventricular drainage set, ventriculoperitoneal shunt, ventilation equipment, masks, nasal cannula) and procedures such as hemodialysis, plasma exchange, continuous venovenous hemodiafiltration, inhalation therapy, blood products transfusion were recorded in these forms. Urinary tBPA levels were determined using high-performance liquid chromatography. General estimating equations with repeated measures analyzed the effect of interventions and devices on urinary BPA levels. A total of 292 urine samples taken from 117 child intensive care patients were studied. When age, sex, and BMI for age z-scores were controlled, cases having endotracheal intubation showed significantly higher meanstandart error (SE) tBPA levels (162.8±28.0 g/g-creatinine) in comparison with no endotracheal intubation (61.8±14.6 g/g-creatinine) (p=0.003). Mean±SE tBPA levels (38.8±12.9 g/g-creatinine) of patients with permanent NG were significantly lower than those without (123.4 ±18.5 g/g-creatinine) (p<0.05). MeanSE urinary tBPA levels of the patients having hemodialysis were 225.8±113.2 g/g-creatinine, and it was 335.1±72.7 g/g-creatinine for those who had hemodialysis but finished it. These values were higher than the mean tBPA levels of patients who did not have hemodialysis (110.8±17.1 g/g-creatinine) (p=0.004). The mean tBPA level (44.3 ± 13.0 g/g-creatinine) of the patients with external drain (extraventricular drainage set, chest tube, surgical drain) was significantly lower than the mean tBPA levels of the patients without an external drain (134.5 ± 20.7 μg / g-creatinine) (p <0.001). The patients using both multiple iv treatment and more than four medical devices showed higher urinary tBPA levels than their counterparts (p=0.007 and p=0.028, respectively). The use of certain medical devices and interventions could increase BPA exposure in pediatric intensive care patients.