Each year in the United States alone, over 300,000 preterm infants are admitted to neonatal intensive care units (NICUs)1,2 where they are exposed to a chemical-intensive hospital environment. Many life-saving and supportive respiratory, nutritional, hematologic, and pharmaceutical therapies in the NICU expose preterm infants to potentially harmful chemicals during a life stage analogous to the third trimester of gestation.3,4 Preterm infants are thus exposed to a chemically pervasive hospital environment during a period of neurodevelopment that is particularly vulnerable to long-term perturbation by environmental chemicals.5,6,7,8

It is well recognized that preterm infants are at elevated risk of developmental delay, cognitive dysfunction, attention deficit hyperactivity disorder, and autism among other neurobehavioral morbidities.9,10,11 Although infants who survive significant illness in the NICU have predictably high rates of disability, for the majority of children born preterm long-term outcomes attributed to “prematurity” are only partially explained by degree of prematurity or severity of illness in infancy.12,13,14,15,16,17 But “prematurity” in and of itself provides no mechanistic explanation to the variable neurodevelopmental outcomes seen in children born preterm. This leaves open the possibility that other factors, including environmental factors, contribute to disease progression. However, there is only a small existing literature investigating exposure to a limited number environmental chemical exposures—primarily phthalates, phenols, and elemental metals—in the NICU.18,19,20,21,22,23,24,25,26 Only a handful of these include source identification and/or assessments of associated outcome. Hospital-based adverse environmental exposures are potentially modifiable if sources can be defined, making this line of investigation particularly relevant to clinical care.

Log in or create a free account to read this content

Gain free access to this article, as well as selected content from this journal and more on nature.com

Access through your institution

or

Sign in or create an account
Continue with Google
Continue with ORCiD