Respiratory Support as a Source of Plasticizer Exposure in Premature Neonates

In the neonatal intensive care unit, premature neonates often are in need of respiratory support, which is provided via several plastic medical devices (PMDs). These devices can be a potential source of plasticizers (phthalates and alternative plasticizers [APs]), which increase the flexibility and durability of PMDs. The aim of this study was to investigate the contribution of respiratory support as a source of plasticizer exposure in neonates by analyzing the concentrations of nine phthalates and 11 APs in nine PMDs commonly used for invasive and noninvasive respiratory support administration using LC-MS/MS and GC-MS. Additionally, a pilot ex vivo experiment mimicking mechanical ventilation was set up to assess plasticizer content in breath condensate. First, we showed that tris-(2-ethylhexyl) trimellitate (TOTM), di-(2-ethylhexyl) terephthalate, and di-(2-ethylhexyl) phthalate (DEHP) are present in relevant amounts in PMDs used for respiratory support. Breath condensate collected after circulation through a ventilation circuit with three different endotracheal tubes containing either TOTM, DEHP, or no significant plasticizers all showed substantial concentrations for DEHP and diethyl phthalate. This work provides novel evidence that respiratory medical devices used in neonatal intensive care units can be a significant source of plasticizer exposure, and introduces an ex vivo leaching model that simulates in vivo ventilation conditions to assess clinical migration behavior of both phthalate and alternative plasticizers.