Phasing out DEHP from plastic indwelling medical devices used for intensive care: Does it reduce the long-term attention deficit of critically ill children?

Vanhorebeek, Ilse; Malarvannan, Govindan; Güiza, Fabian; Poma, Giulia; Derese, Inge; Wouters, Pieter; Joosten, Koen; Verbruggen, Sascha; Jorens, Philippe G.; Berghe, Greet Van den

doi:10.1016/j.envint.2021.106962

Cited by 10 publications

(12 citation statements)

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“…Different types of plastic materials have been reported to leach phthalates differently . For example, indwelling tubings can leach 21% of total DEHP content in 24 h of use, especially in lipophilic solutions such as parenteral solution or blood. , The differences in concentrations measured in our study with those reported earlier may be related to the fact that we used more realistic migration and exposure scenarios, and tested different types of devices. Experimental conditions such as the type of simulants, surface area of products, and duration of contact can significantly influence the amount of phthalates leached.…”

Section: Resultsmentioning

confidence: 59%

“…Phthalates, esters of ortho -phthalic acid, are widely used as plasticizers to improve the flexibility of polyvinyl chloride (PVC) plastics . Phthalates are present in consumer products, including personal care products (PCPs), pharmaceuticals, and medical devices. − For over two decades, studies have shown that phthalates are reproductive and developmental toxicants and elicit carcinogenic, cardiotoxic, hepatotoxic, and nephrotoxic effects in laboratory animals. − The effects of phthalates on the human endocrine system, especially on reproduction, are well documented. , Di(2-ethylhexyl) phthalate (DEHP) and dibutyl phthalate (DBP) are reproductive toxicants. , DEHP has been widely used as a plasticizer in medical devices. ,− Nevertheless, it is not known whether other phthalate diesters such as diethyl phthalate (DEP) and butyl benzyl phthalate (BzBP) are used in medical devices…”

Section: Introductionmentioning

confidence: 99%

“… 1 Phthalates are present in consumer products, including personal care products (PCPs), pharmaceuticals, and medical devices. 2 − 6 For over two decades, studies have shown that phthalates are reproductive and developmental toxicants and elicit carcinogenic, cardiotoxic, hepatotoxic, and nephrotoxic effects in laboratory animals. 7 − 10 The effects of phthalates on the human endocrine system, especially on reproduction, are well documented.…”

Section: Introductionmentioning

confidence: 99%

“… 13 , 14 DEHP has been widely used as a plasticizer in medical devices. 6 , 15 − 17 Nevertheless, it is not known whether other phthalate diesters such as diethyl phthalate (DEP) 18 and butyl benzyl phthalate (BzBP) are used in medical devices. 19…”

Section: Introductionmentioning

confidence: 99%

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Leaching of Phthalates from Medical Supplies and Their Implications for Exposure

Wang

2023

Environ. Sci. Technol.

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In this study, 72 single-use medical products, grouped into four categories, namely, creams/liquids (n = 8), medical devices (n = 46; 15 of 46 labeled "di(2-ethylhexyl)phthalate (DEHP)-free"), first aid products (n = 13), and intravenous (IV) infusion/irrigation fluids (n = 5), were collected from an intensive care unit in a hospital in New York State in 2015 and analyzed for the migration of 10 phthalates in ethanol/water (1:1) mixture for 1 h. The total phthalate concentration (Σ phthalates ) leached from medical products ranged from 0.04 to 54,600 μg. DEHP was the major phthalate found in 99% of the samples analyzed, with the highest amount leached from respiratory support devices (median: 6560 μg). DEHP was also found at notable concentrations in products labeled as "DEHP-free". Direct exposure to phthalates from the use of medical devices and first aid supplies and dermal intake from the use of creams/ lotions were calculated. The highest DEHP exposure dose of 730 μg/kg bw/day was determined from the use of cannula for neonates. This is the first study to document the amount of phthalates leached from various medical supplies and associated exposures.

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Section: Resultsmentioning

confidence: 59%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Leaching of Phthalates from Medical Supplies and Their Implications for Exposure

Wang

2023

Environ. Sci. Technol.

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“…In a study of NICU patients, use of DEHP-free central venous lines for total parenteral nutrition was associated with a significant decrease in cholestasis [ 61 ]. However, in a follow-up to the study evaluating phthalates and ADHD, phasing out DEHP containing devices was shown to reduce DEHP exposure, but there was still significant exposures and the incidence of impaired attention was not reduced [ 62 ].…”

Section: Discussionmentioning

confidence: 99%

Childhood exposures to environmental chemicals and neurodevelopmental outcomes in congenital heart disease

Gaynor

Burnham²,

Ittenbach³

et al. 2022

PLoS ONE

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Background Children with congenital heart defects have an increased risk of neurodevelopmental disability. The impact of environmental chemical exposures during daily life on neurodevelopmental outcomes in toddlers with congenital heart defects is unknown. Methods This prospective study investigated the impacts of early childhood exposure to mixtures of environmental chemicals on neurodevelopmental outcomes after cardiac surgery. Outcomes were assessed at 18 months of age using The Bayley Scales of Infant and Toddler Development-III. Urinary concentrations of exposure biomarkers of pesticides, phenols, parabens, and phthalates, and blood levels of lead, mercury, and nicotine were measured at the same time point. Bayesian profile regression and weighted quantile sum regression were utilized to assess associations between mixtures of biomarkers and neurodevelopmental scores. Results One-hundred and forty infants were enrolled, and 110 (79%) returned at 18 months of age. Six biomarker exposure clusters were identified from the Bayesian profile regression analysis; and the pattern was driven by 15 of the 30 biomarkers, most notably 13 phthalate biomarkers. Children in the highest exposure cluster had significantly lower adjusted language scores by -9.41 points (95%CI: -17.2, -1.7) and adjusted motor scores by -4.9 points (-9.5, -0.4) compared to the lowest exposure. Weighted quantile sum regression modeling for the overall exposure-response relationship showed a significantly lower adjusted motor score (β = -2.8 points [2.5th and 97.5th percentile: -6.0, -0.6]). The weighted quantile sum regression index weights for several phthalates, one paraben, and one phenol suggest their relevance for poorer neurodevelopmental outcomes. Conclusions Like other children, infants with congenital heart defects are exposed to complex mixtures of environmental chemicals in daily life. Higher exposure biomarker concentrations were associated with significantly worse performance for language and motor skills in this population.

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Plasticizer Types

Wypych¹

2023

Handbook of Plasticizers

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Phasing out DEHP from plastic indwelling medical devices used for intensive care: Does it reduce the long-term attention deficit of critically ill children?

Abstract: Phasing out DEHP from plastic indwelling medical devices used for intensive care: Does it reduce the long-term attention deficit of critically ill children?

Cited by 10 publications

References 57 publications

Leaching of Phthalates from Medical Supplies and Their Implications for Exposure

Leaching of Phthalates from Medical Supplies and Their Implications for Exposure

Childhood exposures to environmental chemicals and neurodevelopmental outcomes in congenital heart disease

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