Di-(2-ethylhexyl)-phthalate as plasticizer in PVC respiratory tubing systems: indications of hazardous effects on pulmonary function in mechanically ventilated, preterm infants

Roth, B.; Herkenrath, Peter; Lehmann, H.; Ohles, H D; Hömig, H J; Benz-Bohm, G; Kreuder, Joachim; Younossi-Hartenstein, Amelia

doi:10.1007/bf00442609

Cited by 71 publications

(52 citation statements)

References 34 publications

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“…21 Clinical presentation was similar to that noted with bronchopulmonary disease. Two infants exhibited episodes of respiratory deterioration associated with high concentrations of DEHP extracted from respiratory circuit condensate.…”

Section: Human Studiessupporting

confidence: 61%

Di(2-ethylhexyl)phthalate (DEHP)

Strauss

2004

The Journal of Pediatric Pharmacology and Therapeutics

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REVIEW ARTICLEDi(2-ethylhexyl) phthalate or DEHP is a colorless, oily liquid and notably, with respect to clinical concerns, is soluble in blood and body fluids containing lipoproteins. Despite being listed as a possible human carcinogen in the 1980's, more recent concerns have focused on its potential toxicity as a result of leaching from medical devices into patients via intravenous or enteral routes. Initial discussion of this problem was reported in the medical literature over 20 years ago. This article provides an update on the status of DEHP as a potential reproductive toxin and the potential implications for highrisk population groups (most notably neonates). The use of the precautionary principle for a guidepost in relating human exposure effects to chemical agents, including DEHP, has become a topic relevant to all health care professionals and is discussed herein.

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Section: Human Studiessupporting

confidence: 61%

Di(2-ethylhexyl)phthalate (DEHP)

Strauss

2004

The Journal of Pediatric Pharmacology and Therapeutics

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“…Hillman et al 1975;Latini 2000;Latini and Avery 1999;Loff et al 2000;Plonait et al 1993;Tickner et al 2001). Thus, it is conceivable that prenatal and postnatal exposures may have synergistic and cumulative actions in producing adverse neonatal effects, especially for premature infants with very low birth weight (Roth et al 1988). …”

Section: Discussionmentioning

confidence: 99%

In utero exposure to di-(2-ethylhexyl)phthalate and duration of human pregnancy.

Latini

Felice

Presta

et al. 2003

Environ Health Perspect

465

286

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Phthalate esters are used widely as plasticizers for polyvinylchloride (PVC) formulations in several applications, including medical devices, toys, food wraps, and building products, to impart flexibility to an otherwise rigid PVC. Di-(2-ethylhexyl)phthalate (DEHP) is the most commonly used plasticizer. Because DEHP does not bind with the plastic, it leaches with time and use from vinyl products, thus becoming a ubiquitous environmental contaminant (Bauer and Herrmann 1997;Bradbury 1996;Giam et al. 1978;Griffiths et al. 1985;Mayer et al. 1972;Mes et al. 1974;Øie et al. 1997;Sharman et al. 1994). In particular, leaching of DEHP from PVC medical devices and deposits in tissue have been well documented (Latini 2000;Tickner et al. 2001). Because the DEHP action depends on dose, time, and age (Latini 2000) and because DEHP effects are influenced by the stage of development at exposure among animals (Akingbemi et al. 2001), the DEHP-related exposure risk is potentially higher for the developing fetus and newborn, particularly preterm. Recently, our preliminary findings indicated that the exposure to these environmental contaminants begins during intrauterine life, that these chemicals are able to cross the placental barrier, and that fetal exposure is closely related to maternal exposure (Latini et al. 2003). The aim of this study was to measure concentrations of DEHP and/or its main metabolite, mono-(2-ethylhexyl)phthalate (MEHP), in a larger population of human neonates and to evaluate possible biologic effects from prenatal exposure to DEHP and/or MEHP. Patients and MethodsSubjects. Cord blood samples were collected from 84 consecutive newborns (82 singletons, two twins), born at the general-practice Brindisi Hospital, with the following characteristics: 39 male, 45 female; maternal age at delivery, 29.5 ± 5.1 years (range = 18-42); vaginal delivery, n = 65 (77.4%); gestational age, 38.4 ± 2.2 weeks (range = 27-42); birth weight, 3,220 ± 680 g, (range = 1,150-4,350); 1-min Apgar score, 7.9 ± 0.9; 5-min Apgar score, 8.8 ± 0.5. Eleven of 84 infants were preterm; only three had very low birth weight. Moreover, four infants who were small for gestational age (SGA) were present in our population. None of the examined infants was born after in vitro fertilization pregnancy. The study was approved by the ethics committee of the Brindisi Hospital (Brindisi, Italy), and written informed consent from the parents was obtained. Blood specimens were immediately centrifuged (3,500 × g, 7 min), and serum was stored at -20°C until assay. To avoid any contamination from plasticizers in lab equipment, the serum sample collection, preservation, and treatment were performed only with glass devices. The concentrations of DEHP and MEHP were determined by highperformance liquid chromatography, at the Department of Chemistry of the University of L'Aquila, an institution certified in agreement with the International Organization for Standardization 9001 quality system, as described previously .Data analysis. Data are expressed as mean ± SD...

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“…Because of the cross-sectional nature of these studies, we cannot determine if concentrations of phthalates in the home are also involved in the development of atopic diseases. In a study conducted in pre-term infants with polyvinyl chloride (PVC) respiratory tubing, Roth et al (1988) found these infants to have clinically and radiologically confirmed hyaline membrane disease, which was hypothesized to be caused by the DEHP exposure. Di(2-ethylhexyl) phthalate was also found in the lung tissue of one of the patients who died of a pneumothorax soon after birth (Roth et al 1988).…”

Section: Phthalates (A) Exposurementioning

confidence: 99%

Phthalates and other additives in plastics: human exposure and associated health outcomes

Meeker

Sathyanarayana

Swan

2009

Phil. Trans. R. Soc. B

672

391

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Concern exists over whether additives in plastics to which most people are exposed, such as phthalates, bisphenol A or polybrominated diphenyl ethers, may cause harm to human health by altering endocrine function or through other biological mechanisms. Human data are limited compared with the large body of experimental evidence documenting reproductive or developmental toxicity in relation to these compounds. Here, we discuss the current state of human evidence, as well as future research trends and needs.Because exposure assessment is often a major weakness in epidemiological studies, and in utero exposures to reproductive or developmental toxicants are important, we also provide original data on maternal exposure to phthalates during and after pregnancy (n ¼ 242). Phthalate metabolite concentrations in urine showed weak correlations between pre-and post-natal samples, though the strength of the relationship increased when duration between the two samples decreased. Phthalate metabolite levels also tended to be higher in post-natal samples.In conclusion, there is a great need for more human studies of adverse health effects associated with plastic additives. Recent advances in the measurement of exposure biomarkers hold much promise in improving the epidemiological data, but their utility must be understood to facilitate appropriate study design.

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Di-(2-ethylhexyl)-phthalate as plasticizer in PVC respiratory tubing systems: indications of hazardous effects on pulmonary function in mechanically ventilated, preterm infants

Cited by 71 publications

References 34 publications

Di(2-ethylhexyl)phthalate (DEHP)

Di(2-ethylhexyl)phthalate (DEHP)

In utero exposure to di-(2-ethylhexyl)phthalate and duration of human pregnancy.

Phthalates and other additives in plastics: human exposure and associated health outcomes

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