Phthalate Exposures in the Neonatal Intensive Care Unit

Abstract

Background: Di-2-ethylhexyl phthalate (DEHP), a phthalate compound found in medical devices, may cause toxic effects in premature infants. In this study, the objective is to quantify DEHP exposures from various intravenous and respiratory therapy devices, and to use these values to predict typical exposure for an infant in a neonatal unit. Methods: Common IV products used on infants are directed through various types of IV tubing (IVT) and analyzed for DEHP content. DEHP exposure for infants receiving respiratory therapy was determined indirectly through analysis of urine DEHP metabolites. By deriving these values for DEHP we calculated the daily exposure to DEHP from common IV fluids (IVF) and respiratory devices during hospitalization in a neonatal unit. Results: IVF labeled DEHP-positive showed very high concentrations of DEHP, but when passed through IVT, substantial amounts were adsorbed. DEHP was undetectable with all DEHP-negative IVF tests, except when passed through DEHP-positive IVT. The DEHP leached from most respiratory devices was relatively modest, except that detected from bubble CPAP. In 14 very low birthweight infants, the mean DEHP exposure was 182,369 mcg/kg over 81.2 days of the initial hospitalization. Ninety-eight percent of the exposure was from respiratory devices, with bubble CPAP accounting for 95% of the total DEHP exposure in these infants. Conclusions: The DEHP exposure in our neonatal unit can be reduced markedly by avoiding or modifying bubble CPAP equipment and avoiding IV tubing containing DEHP.

Risk Assessment of Phthalates and Their Metabolites in Hospitalized Patients: A Focus on Di- and Mono-(2-ethylhexyl) Phthalates Exposure from Intravenous Plastic Bags

“…This number is 2.73-fold higher than the mean MEHP concentration measured by Calafat and colleagues in urine samples retrieved from premature newborns [ 69 ] and over 18 times greater than the average value reported by Weuve et al in neonates [ 70 ]. Infants likely have a different DEHP metabolism compared to older children or adults, including low glucuronidation activity, which may increase the half-life of MEHP and delay the excretion of DEHP [ 71 ], as well as high levels of gastric lipases, which are involved in the metabolism of DEHP to MEHP [ 70 ]. MEHP has been associated with a number of adverse effects in neonates, such as the inhibition of neutrophil migration and apoptosis [ 72 ].…”

“…Not to mention that drugs added to IV injections also affect and mostly increase the amount of leached PAEs into solution, making drug injections even more problematic. More often than not, neonates in ICU units requiring IV injections are also on respirators connected through PVC tubing, increasing their exposure to PAEs [ 71 ]. In addition to medical devices, non-medical sources of PAE exposure should also be taken into account, including ambient air, food in plastic packaging, and any other plastic items that could be around a patient.…”

Exposure of preterm neonates receiving total parenteral nutrition to phthalates and its impact on neurodevelopment at the age of 2 months

“…Phthalates can be another significant source of contamination of TPN solutions because they are used to soften plastics and thus are widely utilized in medical devices, primarily in bags and infusion tubing for intravenous solutions and feeding 12 – 15 . As phthalates are not chemically bound to the plastic matrix, they leach out and migrate into the air, food, or other materials 13 .…”

Phthalate Exposure: From Quantification to Risk Assessment

“…Intensive Care Units [16], where the possibility of the exposure of an extremely fragile population to the pollutants released from medical devices was tested.…”