BACKGROUND: Premature neonates have an increased risk of long-term effects, including impaired respiratory and neurodevelopment. During NICU admission, they are exposed to endocrine-disrupting phthalates and alternative plasticizers. The objective was to study the association between cumulative NICU-based plasticizer exposure and respiratory and neurodevelopmental outcome during the first year of life. METHODS: Premature neonates (gestational age <
31 weeks and/or birth weight <
1500 g) were prospectively enrolled at the Antwerp University Hospital, Belgium. Outcome was assessed at 12 months corrected age, using the Bayley Scales of Infant and Toddler Development-III and validated questionnaires for respiratory outcome. Urinary concentrations of plasticizers' biomarkers were measured weekly during NICU stay. Weighted quantile sum regression was utilized to assess associations between plasticizer biomarkers' mixtures and outcome. RESULTS: Exposure of premature neonates (n = 110) to specific plasticizer mixtures correlated with worse fine motor (ß -0.96
95%-CI -1.76, -0.15
p = 0.02) and receptive language development (ß -0.77
95%-CI -1.23, -0.32
p = 0.002), and better gross motor (ß 2.24
95%-CI 0.62, 3.86
p = 0.01) and expressive language development (ß 1.50
95%-CI 0.33, 2.67
p = 0.02). NICU exposure to different plasticizer mixtures was associated with eczema (aOR 3.12
95%-CI 1.23, 9.11
p = 0.02), repeated ear infections (aOR 5.53
95%-CI 1.87, 23.14
p = 0.01), and respiratory-related healthcare visits during the first year of life (aOR 8.50
95%-CI 2.05-55.91
p = 0.01). CONCLUSIONS: Cumulative NICU exposure to phthalates and alternative plasticizers was associated with increased respiratory morbidity and eczema during the first year of life. Exposure to specific plasticizer mixtures correlated with worse or better neurodevelopment at one year of age.