Leslie Oakes, Kimberly Pritchard, Rachel Schupp,

1
Infant Exposure to Bisphenol-A (BPA)

• Leslie Oakes, Kimberly Pritchard, Rachel Schupp,
• Margaret Smith, Tracie Summers

2
PICO Question

• What are the negative health effects on infants
  when exposed to bottles that contain varying
  concentrations of Bisphenol-A?

3
PICO Defined

• POPULATION Infants
• INTERVENTION Bottles that leach smaller amounts
  of BPA
• COMPARISON Bottles that leach larger amount of
  BPA
• OUTCOMES Decrease negative health effects

4
Definitions

• Bisphenol-A (BPA) a chemical commonly used in
  the manufacture of polycarbonate plastic
  (Gibson. R. 2007)
• Safe BPA Level 50 mcg/kg/day as stated by
  United States (US) Food Drug Administration
  (FDA) and US Environmental Protection Agency
  (EPA)
• Infants 0-12 months of age

5
Definitions

• Polycarbonate Plastic A clear or tinted,
  unbendable plastic in which BPA is the main
  component (Davis, M., et al 2008)
• Baby bottles
• Reusable water bottles
• Plastic baby toys
• Microwavable food containers
• Leaching Polycarbonate plastic breaks down when
  heated and causes migration of BPA into food or
  beverages that come into contact with this
  plastic (Gibson. R. 2007)

6
Problem and Prevalence

• BPA, a main component of polycarbonate plastic,
  is used to manufacture 95 of popular plastic
  baby bottles. Evidence has shown that BPA is
  linked to long term negative health effects in
  animals and humans.

7
Negative Health Effects

• Increased risk for certain cancers
• Reproductive disorders
• Early onset of puberty
• Immune disorders
• Neurological changes
• BPA causes significant health side effects well
  below the low safety dose of 50 micrograms/kg/day
• Welshons, W., Nagel, S., Vom Saal, F. (2006).

8
Types of Research

• Bottle Comparison
• Davis, M., et al (2008)
• Gibson, R. (2007)
• Le, H. H., Carlson, E. M., Chua, J. P.,
  Belcher, S. M. (2008)
• Polyzou , C., et al (2008)
• Adult Studies
• Lang , I. A., et al (2008)
• Neonatal Intensive Care Unit (NICU)
• Calafat , A., et al (2009)

9
Gibson, R. (2007)

• A 2,800 parents participated in the 2005-2006
  consumer survey.
• Five popular baby bottle brands
• Dr. Browns, Avent, Evenflo, Gerber, and Playtex
• All bottles showed BPA bring leached (5 10
  ng/mL) from all brands exposed to water at 8O C

10
Davis, M., et al (2008)

• Ten new polycarbonate plastic baby bottles were
  purchased from a variety of major retailers from
  the US
• Avent, Disney/The First Years, Dr. Browns,
  Evenflo, Gerber, and Playtex
• Bottles did not show notable levels of BPA being
  leached at room temperature
• Bottles showed significant levels (5-9 ng/mL) of
  BPA being leached when heated to 80 C

11
Polyzou , C., et al (2008)

• Nine new plastic baby bottles were purchased from
  a variety of retailers in Toronto and Ontario
  Canada
• Gerber, Avent and Playtex
• These bottles did not show notable levels (gt
  0.065 ng/mL) of leaching at room temperature
• All bottles showed significant levels of leaching
  in the range of 5-8 ng/mL when heated to 80 C

12
Bottle Comparison
13
Le, H. H., Carlson, E. M., Chua, J. P.,
Belcher, S. M. (2008)

• New or used polycarbonate drinking bottles vs.
  high density polyethylene bottles
• Standardized wash/rinsing procedure performed
• Detectable levels of BPA identified in all
  polycarbonate samples.
• Concentration of BPA doubled when samples were
  heated to 100 C
• At room temperature polycarbonate bottles leached
  BPA

14
Lang , I. A., et al (2008)

• The study included non-institutionalized US
  adults aged 18- 74 years
• The study sample included 694 men and 761 women
  for a total of 1455
• Health effects
• Cardiovascular diagnosis
• Diabetes
• Abnormal concentrations of liver enzymes

15
Calafat , A., et al (2009)

• Forty-two infant diapers were tested from two
  Boston area NICU facilities for BPA in the urine
• The results showed BPA levels were ten times
  higher than previously reported for adults and
  twice as high from children 6-11 years old
• Plastic medical devices are a significant source
  of BPA exposure

16
Research Interpretation

• The plastic baby bottle studies are limited to
  the amount of BPA leached in water at 80 C
• Research shows that BPA is leached from majority
  of polycarbonate plastic baby bottles
• BPA has been linked to negative health effects
• NICU infants are at greater risk for negative
  health effects due to high exposure to BPA and
  immature body systems
• Products containing BPA are commonly purchased
  among consumers

17
Recommendations

• Consumers
• Purchase BPA free products
• Plastic bottles should not be heated
• Avoid harsh detergents and bristle brushes
• Hospitals
• Research and implement change
• Use BPA free or glass bottles
• Educate parents
• Davis M., et al (2008) and Gibson. R. (2007)

18
Hospital Implementation

• Step 1 Challenge nurses to apply the information
  
• Step 2 Form a quality improvement committee to
  educate hospital staff
• Step 3 Advocate for BPA free bottles
• Step 4 Hospitals obtain BPA free products from
  the formula companies
• Step 5 Educate Parents during pre natal classes
  and before discharge
• Step 6 Continue to advocate at the local and
  national level

19
Evaluation

• Evaluate hospital compliance on the use of BPA
  free products
• Evaluate the effectiveness of teaching to parents
  through phone surveys four weeks after
  discharge
• Implement and evaluate longitudinal studies and
  compare to current research
• Evaluate correlation between decreased BPA
  exposure and the negative health effects in
  infants.

20
Suggestions for Further Research

• Longitudinal studies to examine the negative
  health effects of BPA in infants
• BPA leaching into other liquids besides water
  such as milk and juice
• Infant exposure to BPA in the hospital setting
• Research data to support the need for stronger
  regulations and guidelines.

21
Conclusion

• BPA causes significant health side effects well
  below the low safety dose of 50 micrograms/kg/day
• Safe BPA levels need to be reevaluated by the US
  EPA and FDA
• Parents need to be aware of BPA and the negative
  effects it can cause

22
References

• Calafat, A., Weuve, J., Ye, X., Jia, L., Hu, H.,
  Ringer, S., Huttner, K., Hauser, R. (2009).
  Exposure to Bisphenol A and other phenols in
  neonatal intensive care unit premature infants.
  Environmental Health Perspectives, 117(4),
  639-644. Retrieved April 1, 2009, from
  http//www.ehponline.org/members/2008
• /0800265/0800265.pdf.
• Davis, M., Foulds, J., Freeman, A., Khatter, K.,
  Polyzou, C., Robinson, J., Schade, M., Smith,  
  R., Vom-Saal, D. (2008). Baby's toxic bottle
  (Rep.). Retrieved February 22, 2009, from 
  http//www.environmentcalifornia.org/upload
  s/wm/HH/wmHHMjKT2OLz4Nc4kXzynQ/Toxic-Baby-Bottles.
  pdf. 

23
References

• Gibson, R. (2007). Toxic baby bottles (Rep.).
  Retrieved February 22, 2009, from
  http//www.environmentcalifornia.org/uploads/wm/HH
  /wmHHMjKT2OLz4Nc4kXzynQ/Toxic-Baby-Bottles.pdf.
• Lang, I. A., Galloway, T. S., Scarlett, A.,
  Henley, W. E., Depledge, M., Wallace, R. B.,
  Melzer, D. (2008). Association of urinary
  Bisphenol A concentration with medical disorders
  and laboratory abnormalities in adults. The
  Journal of the American Medical Association,
  300(11), 1303-1310.

24
References

• Le, H. H., Carlson, E. M., Chua, J. P.,
  Belcher, S. M. (n.d.). Manuscript submitted for
  publication, Department of Pharmacology and Cell
  Biophysics, University of Cincinnati College of
  Medicine. Retrieved February 20, 2009, from
  National Institutes of Health Public Access.
• Polyzou, C., Khatter, K., Freeman, A., Foulds,
  J., Smith, R., Saal, F. V., Stone, C. (2008).
  Toxic baby bottles in Canada (Rep.). Retrieved
  February 08, 2009, from http//www.toxicnation.ca/
  files/toxicnation/ report/ToxicBabyBottleReport.pd
  f.

25
References

• Welshons, W., Nagel, S., Vom Saal, F. (2006).
  Large Effects from Small Exposures. III. 
  Endocrine Mechanisms Mediating Effects of
  Bisphenol A at Levels of Human Exposure.
  Endocrinology, 147(6), S56-S69. Retrieved
  February 22, 2009, from http//endo.endojournals.o
  rg/cgi/reprint/147/6/s56.