Abstract
Purpose: The purpose of this study was to evaluate whether infusion lines are able to leach plasticizers in substantial amounts and thus be a candidate substance for hepatotoxic effects during long-term total parenteral nutrition (TPN). Methods: TPN solutions, blood products, and selected drugs typical for preterm infants concerning amount, content, and infusion time were perfused through common polyvinylchloride (PVC) infusion lines. Concentration of diethylhexyl-phthalate (DEHP) before and after perfusion was determined by gas chromatography/mass spectrometry. Results: Daily quantities of DEHP by 24-hour infusions were Lipid emulsion 20%: 10185.6 μg; aminoacid/glucose-solution: 116.2 μg; midazolaminfusion for sedation: 26.4 μg; fentanyl for sedation: 132.5 μg; propofol for sedation: 6561.0 μg. The amount of DEHP by single doses of blood products (20 mL) were packed red blood cells: 144-608 μg; platelet rich plasma: 928 μg; and fresh frozen plasma: 552-8108 μg. The dose of DEHP for a typical preterm neonate requiering TPN and additional therapy like sedation or blood products is at minimum 10 mg and can easily reach 20 mg/d. Conclusion: This large amount of DEHP is especially disturbing, because it effects the most vulnerable patients (neonates). Whether there is a relation to TPN-induced hepatobiliary dysfunction remains to be elucidated and is under investigation. With respect to recent literature, a biological effect of these doses must be assumed. J Pediatr Surg 35:1775-1781. Copyright © 2000 by W.B. Saunders Company.
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