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Endocrine Disruptors in the NICU

Endocrine Disruptors in the NICU

The Issue

Health concerns related to endocrine-disrupting chemicals (EDCs) have been in the news in recent months, and they matter to those who work with neonates because of their possible effect on neonatal development. An endocrine disruptor interferes with the communication system of glands, hormones, and cellular receptors that control the body's internal functions, one of which is development of the reproductive system. A concern in perinatology is that EDCs might be interfering with normal development of reproductive organs, especially in males, because male genital development is dependent on specific hormones being present at critical times during fetal development. Exposure during these critical developmental windows might be a cause of atypical genitalia (e.g., cryptorchidism and hypospadias) in newborn boys, and, later on, of infertility, testicular cancer, and prostate cancer, all conditions that have increased in incidence since these chemicals became ubiquitous in our lives. The evidence for adverse reproductive outcomes from exposure to EDCs is strong, and evidence for their effects on other endocrine systems (including the neuroendocrine system and the thyroid), obesity and metabolism, and insulin and glucose homeostasis is also mounting.

A group of highly heterogeneous molecules, EDCs include synthetic chemicals used as industrial solvents or lubricants and their byproducts (polychlorinated biphenyls [PCBs], polybrominated biphenyls [PBBs], dioxins), plastics (bisphenol A [BPA]), plasticizers (phthalates), pesticides (methoxychlor, chlorpyrifos, dichlorodiphenyltrichloroethane [DDT]), fungicides (vinclozolin), and pharmaceutical agents (diethylstilbestrol [DES]). Furthermore, some natural chemicals found in human and animal food (e.g., phytoestrogens) can also act as endocrine disruptors.

EDCs are widely consumed and are even found in infant formula. Two EDCs of particular concern for infants and children are BPA and phthalates. BPA is a synthetic chemical used in hard polycarbonate plastics, such as baby bottles and infant incubators. BPA acts as a weak estrogen in the body. Phthalates are synthetic chemicals used to soften polyvinylchloride products. Phthalates are found in many flexible plastic products (such as intravenous tubing) and in personal care products (shampoos and lotions).

Phthalates are anti-androgenic: they oppose the effect of hormones necessary for male reproductive development. Some exposure to these chemicals comes from inhalation of contaminated dust, but other exposure comes from foods or fluids that are in direct contact with BPA-containing or phthalate-containing products. Attention to this latter area of exposure is critical to preventing harm from potential EDCs.

The Legislation

To err on the side of caution, we must learn more about EDCs and their potential effects on humans. To do otherwise would be to fail in our role as advocates for the health of newborns. On July 13, 2011, the Endocrine-Disrupting Chemicals Exposure Elimination Act of 2011 was introduced in the U.S. Senate by Senator John Kerry (D-MA) and in the U.S. House of Representatives by Congressman Jim Moran (D-VA). The act propels the rigorous 21st-century health research being done through the National Institute of Environmental Health Sciences (NIEHS) to the forefront of regulatory decision making. It facilitates cooperation between NIEHS, the Environmental Protection Agency, and other regulatory agencies to reduce exposure to chemicals identified as endocrine disruptors.

This act is essential to facilitate and strengthen current chemical legislation such as the Safe Drinking Water Act, the Clean Water Act, and the Clean Air Act, as well as new legislation such as the Safe Chemicals Act of 2011 and the Endocrine Disruptor Screening Enhancement Act of 2010.

The Opportunity

Because this issue affects our neonatal patients, NANN's Health Policy and Advocacy Committee has been monitoring developments and seeking to educate members about the proposed legislation. A call for action has been posted on NANN's website, and members are encouraged to contact their elected officials in Washington and express their views about the Endocrine-Disrupting Chemicals Exposure Elimination Act of 2011. If your elected officials are not already cosponsors, ask them to cosponsor this bill.

For more information on how to advocate for this issue, visit the Endocrine Disruption Exchange website.