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.
Highlights
Current neonatal intensive care units (NICU) expose term and extremely low gestational age newborns to various plastic medical devices (MD)
We demonstrated that neonates were significantly exposed to di-(2ethylhexyl) phthalate (DEHP) and alternative plasticizers that are contained in the MD used for their care management in NICU, i.e., drug administration
extracorporeal membrane oxygenation (ECMO) patients are highly exposed to DEHP, for which a direct association with urinary metabolites may be established
Summary
Current neonatal intensive care units (NICU) expose term and extremely low gestational age newborns to various plastic medical devices (MD). These MD include, for the most part, MD used for the administration of drugs, such as peripheral and central venous access catheters, infusion lines, feeding tubes and tubing, and airway management devices. It is widely accepted that these plasticizers can migrate from the PVC matrix into drug solutions and come into contact with the patient [1,2,3].
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