Association between Urinary Metabolites and the Exposure of Intensive Care Newborns to Plasticizers of Medical Devices Used for Their Care Management

Abstract

Care management of newborns in the neonatal intensive care unit (NICU) requires numerous PVC (PolyVinyl Chloride) medical devices (MD) containing plasticizers that can migrate and contaminate the patient. We measured the magnitude of neonates’ exposure to plasticizers (di-ethylhexylphthalate (DEHP) and alternatives) in relation to urinary concentrations of their metabolites. Plasticizers’ exposure was evaluated (1) by calculating the amounts of plasticizers prone to be released from each MD used for care management, and (2) by measuring the patients’ urinary levels of each plasticizers’ metabolites. 104 neonates were enrolled. They were exposed to di-isononylphthalate (DINP), especially via transfusion and infusion MD, and to DEHP via ECMO (Extra Corporeal Membrane Oxygenation) and respiratory assistance MD. Mean exposure doses exceeded the derived no-effect level of DINP and DEHP by a 10-fold and a 1000-fold factor. No PVC MD were plasticized with di-isononylcyclohexane-1,2-dicarboxylate (DINCH). High urinary concentrations of DEHP metabolites were directly correlated with DEHP exposure through ECMO MD. Urinary concentrations of DINP metabolites in transfused patients were also high. DINCH metabolites were found in urine, suggesting another route of exposure. Neonates in NICU are considerably exposed to plasticizers, with magnitudes varying with the type of MD used. The high exposure to DEHP and DINP leads to a risk of their metabolites’ toxicity.

Regrettable Substitutes and the Brain: What Animal Models and Human Studies Tell Us about the Neurodevelopmental Effects of Bisphenol, Per- and Polyfluoroalkyl Substances, and Phthalate Replacements

“…Phthalate exposure has been linked to effects on the neuroendocrine and reproductive systems and neurodevelopment, as well as to increases in cancer, asthma, diabetes, and other health concerns [37,63]. Their effects on neurodevelopment are of special concern given the extensive phthalate exposure that premature and intensive care newborns are exposed to through medical tubing [64]. In 2017, the United States banned eight phthalates from use in children s products, including toys.…”

DEHP exposure impairs human skeletal muscle cell proliferation in primary culture conditions: preliminary study

“…1). Considering the apparent self-diffusion coe cient (D app ) of DEHP in the medium to be 4.04 x 10 − 7 cm min − 1 (Hara 1993;Bernard et al 2021), the concentration of dissolved DEHP in culture medium was estimated to be approximately 1000 µM (1 mM). Where dissolved DEHP is the portion of the phthalate in contact with the cells in culture and can be absorbed by them.…”

Comment on Bernard et al. Association between Urinary Metabolites and the Exposure of Intensive Care Newborns to Plasticizers of Medical Devices Used for Their Care Management. Metabolites 2021, 11, 252

“…The recent publication “Association between Urinary Metabolites and the Exposure of Intensive Care Newborns to Plasticizers of Medical Devices Used for Their Care Management” by L. Bernard et al (2021) [ 1 ] caught our interest.…”