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Medical devices used in NICU: The main source of plasticisers' exposure of newborns
Lise Bernard1, Morgane Masse2, Benoît Boeuf3
1Université Clermont Auvergne, Clermont Auvergne INP, CNRS, CHU Clermont Ferrand, ICCF, F-63000 Clermont-Ferrand, France.
Insights
Newborns in NICU are exposed to concerning levels of di-(2-ethylhexyl)phthalate (DEHP) from medical devices. While levels decrease after NICU discharge, safer alternatives to DEHP in medical plastics are crucial.
Area of Science:
- Environmental Health
- Toxicology
- Neonatal Medicine
Background:
- Phthalates and plasticizers in medical devices (MD) can leach into patients, posing health risks.
- Neonatal Intensive Care Unit (NICU) populations are particularly vulnerable to endocrine disruptors due to intensive interventions and immature metabolism.
Purpose of the Study:
- To assess and compare urinary levels of di-(2-ethylhexyl)phthalate (DEHP), di-(2-ethylhexyl)terephthalate (DEHTP), and tri-(2-ethylhexyl)trimellitate (TEHTM) metabolites in NICU newborns.
- To identify sources of exposure and factors influencing phthalate levels in this high-risk population.
Main Methods:
- A multicentric biomonitoring study involving 97 newborns in NICU.
- Collection of daily urinary samples during NICU stay and at hospital discharge.
- Investigation of MD sources and patient-specific exposure factors.
Main Results:
- Newborn exposure to DEHP metabolites was significantly higher (5-228 times) than DEHTP and TEHTM metabolites.
- Urinary concentrations of DEHP and TEHTM metabolites decreased significantly after NICU discharge.
- Medical devices for respiratory support, infusion, nutrition, and transfusion were primary exposure sources; lower gestational age and body weight increased exposure.
Conclusions:
- Elevated DEHP metabolite levels in NICU patients remain a significant concern.
- Substitution of DEHP in MD with potentially safer alternatives like TEHTM and DEHTP is recommended, especially for neonatal care.
Abstract:
Phthalates and other plasticisers are extensively used in medical devices (MD) from which they can leach out and lead to potential multiple problems for the patients. This exposure is a major issue because it is associated with reproductive and neurodevelopment disorders. The Neonatal Intensive Care Units (NICU) population is at high risk due to the daily intensive medical interventions, the reduced ability of newborns to remove these contaminants and their higher sensitivity to endocrine disruptors. We conducted a multicentric biomonitoring study to assess and compare the urinary levels of DEHP (di-(2-ethylhexyl)phthalate), DEHTP (di-(2-ethylhexyl)terephthalate) and TEHTM (tri-(2-ethylhexyl)trimellitate) metabolites as biomarkers of this exposure during and after the newborns' stay in NICU. Daily urinary samples were collected in NICU and at discharge from the hospital for each patient. MD sources and exposure factors were also investigated. 508 urinary samples from 97 patients enrolled in centres 1 and 2 (C1/C2) were collected. The exposure of newborns to DEHP was greater than that of DEHTP and TEHTM, with a median concentration of DEHP metabolites (C1:195.63 ng/mL;C2:450.87 ng/mL) respectively 5 to 10 times higher and 57 to 228 times higher than the median concentrations of DEHTP and TEHTM metabolites. The urinary concentrations of DEHP and TEHTM metabolites were significantly lower at discharge than in NICU, with a 18-and 35-fold decrease for DEHP and a 4 and 8-fold decrease for TEHTM, respectively for C1 and C2, but were similar for DEHTP metabolites. MD used for respiratory assistance, infusion therapy,enteral nutrition and transfusion were the main sources of exposure. Smaller gestational age and body weight significantly increased the newborns' exposure. The elevated levels of DEHP metabolites in NICU patients are still alarming. Additional efforts are necessary to promote its substitution in MD by possibly safer alternatives such as TEHTM and DEHTP, particularly when used for the care of newborns.
