Plasticizers in the neonatal intensive care unit: A review on exposure sources and health hazards

Abstract

Plasticizers, used to increase the flexibility of plastic materials, can leach into the environment and the human body. Various adverse health effects are attributed to exposure to plasticizers, particularly phthalates. Premature newborns admitted to a neonatal intensive care unit (NICU) are exposed to many indwelling plastic devices containing plasticizers while in a developmentally vulnerable period. This is the first comprehensive review of its kind, providing an overview of DEHP and alternative plasticizers (APs), their sources and degree of exposure in the NICU, and the resulting health risks in (premature) infants. Despite the 2017 EU Medical Devices Regulation (2017/745), di-(2-ethylhexyl) phthalate (DEHP) is still a commonly present plasticizer in plastic medical devices in the NICU, with current labelling being insufficient to guarantee absence. Estimated NICU exposures remain elevated above the tolerable daily intake. Medical procedures leading to the highest exposure of phthalates and APs, are extracorporeal membrane oxygenation, blood transfusion, parenteral nutrition and respiratory support.As traditional matrices, such as blood and urine, are not always readily available in neonates, the accumulation of plasticizers in alternative matrices, such as hair and nails, provides an opportunity to study long-term accumulation of toxic chemicals. Impaired respiratory and neurodevelopment correlate with phthalate exposure at both biological and epidemiological levels in childhood, yet knowledge gaps about the effects in neonates prevail. Some APs provide interesting opportunities to reduce toxicity, but human data regarding health effects remain limited. Although toxicologists and regulators have addressed the problem for some time, awareness is lacking mainly among healthcare professionals.

Leaching of Phthalates from Medical Supplies and Their Implications for Exposure

“…Phthalates, esters of ortho -phthalic acid, are widely used as plasticizers to improve the flexibility of polyvinyl chloride (PVC) plastics . Phthalates are present in consumer products, including personal care products (PCPs), pharmaceuticals, and medical devices. − For over two decades, studies have shown that phthalates are reproductive and developmental toxicants and elicit carcinogenic, cardiotoxic, hepatotoxic, and nephrotoxic effects in laboratory animals. − The effects of phthalates on the human endocrine system, especially on reproduction, are well documented. , Di­(2-ethylhexyl) phthalate (DEHP) and dibutyl phthalate (DBP) are reproductive toxicants. , DEHP has been widely used as a plasticizer in medical devices. ,− Nevertheless, it is not known whether other phthalate diesters such as diethyl phthalate (DEP) and butyl benzyl phthalate (BzBP) are used in medical devices…”

Highly stable and highly stretchable poly(vinyl chloride)‐based plastics prepared by adding novel green oligomeric lactate plasticizers

“…Nevertheless, more and more studies have shown that phthalate plasticizers are potentially toxic to humans (reproductive toxicity, carcinogenicity, etc.) and tend to accumulate in the natural environment, which makes their application in sensitive fields strictly restricted in Europe, Japan, the United States and other countries 17–21 . Therefore, it is of great significance to develop green and efficient environmentally friendly plasticizers to prepare high‐performance PVC‐based plastics suitable for high‐end applications.…”

“…and tend to accumulate in the natural environment, which makes their application in sensitive fields strictly restricted in Europe, Japan, the United States and other countries. [17][18][19][20][21] Therefore, it is of great significance to develop green and efficient environmentally friendly plasticizers to prepare high-performance PVC-based plastics suitable for highend applications.…”