Effects of preterm birth and postnatal exposure to metal mixtures on neurodevelopment in children at 24 months of age

Chi Sian Kao, Yen Tzu Fan, Ling Chu Chien, Kai Wei Liao, Jui Hsing Chang, Chyong Hsin Hsu, Yi Jhen Chen, Chuen Bin Jiang

Research output: Contribution to journalArticlepeer-review


The effects of early-life metal exposure on neurodevelopment in very low birth weight preterm (VLBMP) children (with a birth weight of <1500 g and a gestational age of <37 weeks) have not been clearly established. We aimed to investigate associations of childhood exposure to multiple metals and preterm low birth weight with neurodevelopment among children at 24 months of corrected age. VLBWP children (n = 65) and normal birth weight term (NBWT) children (n = 87) were enrolled from Mackay Memorial Hospital in Taiwan between December 2011 and April 2015. Lead (Pb), cadmium (Cd), arsenic (As), methylmercury (MeHg), and selenium (Se) concentrations in the hair and fingernails were analyzed as biomarkers for metal exposure. The Bayley Scale of Infant and Toddler Development, Third Edition, was used to determine neurodevelopment levels. VLBWP children had significantly lower scores in all development domains compared to NBWT children. We also investigated preliminary exposure levels of VLBWP children to metals as reference values for future epidemiological and clinical survey. Fingernails are a useful biomarker for metal exposure to evaluate the effects on neurological development. A multivariable regression analysis revealed that fingernail Cd concentrations were significantly negatively associated with cognition (β = −0.63, 95% confidence interval (CI): −1.17 to −0.08) and receptive language function (β = −0.43, 95% CI: −0.82 to −0.04) among VLBWP children. VLBWP children with a 10-μg/g increase in the As concentration in their nails had a 8.67-point lower composite score in cognitive ability and a 1.82-point lower score in gross-motor functions. Effects of preterm birth and postnatal exposure to Cd and As were associated with poorer cognitive, receptive language, and gross-motor abilities. VLBWP children are at risk for neurodevelopmental impairments when exposed to metals. Further large-scale studies are needed assess to the risk of neurodevelopmental impairments when vulnerable children are exposed to metal mixtures.

Original languageEnglish
Pages (from-to)86856-86865
Number of pages10
JournalEnvironmental Science and Pollution Research
Issue number37
Publication statusPublished - Aug 2023


  • Bayley Scale
  • Hair and fingernail
  • Metal
  • Neurodevelopment
  • Very low birth weight preterm children

ASJC Scopus subject areas

  • Environmental Chemistry
  • Pollution
  • Health, Toxicology and Mutagenesis


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