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Exposure to perfluoroalkyl substances through human milk in preterm infants

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Abstract

Perfluoroalkyl substances (PFASs) are environmental contaminants that have been shown to exert toxic effects, which are dependent upon concentration, in animals and humans. No specific data on the exposure of preterm infants to PFASs are available. We aimed to quantify the potential exposure of preterm infants to PFASs through human milk (HM), to be compared to the exposure data recently reported for infants by EFSA. The amount of PFASs in ten preterm (PHM) and ten donor HM (DHM) samples was evaluated, and the expected daily intake (EDI) at full enteral feeding was calculated. This EDI was compared to the mean and the 95th centile dietary exposure ranges at the lower bound for infants issued by EFSA. The calculated median EDI for total PFASs was 20.72 ng/kg/day (range 10.72–107.84) for PHM and 17.92 ng/kg/day (range 6.4–28.96) for DHM, which were both higher than mean exposure ranges reported for infants (2.4–12.2 ng/kg/day). The calculated EDI for DHM was far more similar to the 95th centile (4.5–27.9 ng/kg/day) dietary exposure ranges. For PHM samples, higher EDI values were obtained, with 4 out of 10 samples exceeding the upper limit of the 95th centile range.

Conclusion: The exposure of preterm infants to PFASs through HM feeding might exceed reference values reported for older and healthier infants. Given the immunological and developmental vulnerability of preterm infants, the risks related to their exposure to PFASs should be further investigated, also focusing on how maternal exposure and subsequent transfer through HM feeding can be reduced.

What is Known:

• Perfluoroalkyl substances (PFASs) are environmental contaminants that have been shown to exert toxic effects, which are dependent upon concentration, in animals and humans. The EFSA has recently issued reference values for PFASs exposure for different age groups.

• Infants might be exposed to PFASs prenatally, as these substances can cross the placenta, and postnatally, through breastfeeding. No specific data about exposure of preterm infants through human milk (HM) feeding are currently available.

What is New:

• The exposure of preterm infants to PFASs through HM feeding might exceed reference values reported for older and healthier infants.

• Given the immunological and developmental vulnerability of preterm infants, the risks related to their exposure to PFASs deserve further investigation. As HM represents the optimal feeding for preterm infants, it will be fundamental to focus on how maternal exposure and subsequent transfer through HM feeding can be reduced.

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Fig. 1

Abbreviations

DHM:

Donor human milk

EDI:

Estimated daily intake

GA:

Gestational age

HM:

Human milk

PFASs:

Perfluoroalkyl substances

PFOA:

Perfluoro-n-octanoic acid

PFOS:

Sodium perfluoro-1-octanesulfonate

PFHxS:

Sodium perfluoro-1-hexanesulfonate

PFNA:

Perfluoro-n-nonanoic acid

PHM:

Preterm human milk

THM:

Term human milk

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Authors and Affiliations

  1. Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Via Massarenti 9, 40138, Bologna, (BO), Italy

    Arianna Aceti, Francesca Vitali, Isadora Beghetti & Luigi Corvaglia

  2. Human Milk Bank “Allattami”, Via Cadriano 27/2, 40127, Bologna, (BO), Italy

    Arianna Aceti, Francesca Vitali, Isadora Beghetti & Luigi Corvaglia

  3. CABA-Lab, Department of Veterinary Medical Sciences (DIMEVET), University of Bologna, Via Tolara di Sopra 50, 40064, Ozzano Emilia, (BO), Italy

    Andrea Barbarossa, Teresa Gazzotti, Elisa Zironi & Giampiero Pagliuca

  4. Health Sciences and Technologies-Interdepartmental Centre for Industrial Research (CIRI-SDV), University of Bologna, Via Tolara di Sopra 50, 40064, Ozzano Emilia, (BO), Italia

    Andrea Barbarossa, Teresa Gazzotti, Elisa Zironi & Giampiero Pagliuca

Authors
  1. Arianna Aceti
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  2. Andrea Barbarossa
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  3. Teresa Gazzotti
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  4. Elisa Zironi
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  5. Giampiero Pagliuca
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  6. Francesca Vitali
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  7. Isadora Beghetti
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  8. Luigi Corvaglia
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Contributions

All the authors conceived the study; AR, FV, and IB collected samples; AB, TG and EZ conducted sample analysis; AA and AB performed data interpretation; AA and AB wrote the first draft of the paper under the supervision of GP and LC. All the authors gave approval of the final version of the manuscript.

Corresponding author

Correspondence to Andrea Barbarossa.

Ethics declarations

Ethics approval

The study was approved by the Ethical Committee of Sant’Orsola-Malpighi Hospital, Bologna, Italy (study ID 60/2016/U/Tess).

Consent to participate and to publish

Written informed consent was obtained from all individual participants included in the study.

Conflict of interest

The authors declare no competing interests.

Additional information

Communicated by Daniele De Luca

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Aceti, A., Barbarossa, A., Gazzotti, T. et al. Exposure to perfluoroalkyl substances through human milk in preterm infants. Eur J Pediatr 180, 3047–3051 (2021). https://doi.org/10.1007/s00431-021-04073-4

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  • DOI: https://doi.org/10.1007/s00431-021-04073-4

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