Exposure to Phthalates of Critically Ill Children: a Pilot Single Center Study
Journal Title: Biomedical Journal of Scientific & Technical Research (BJSTR) - Year 2018, Vol 6, Issue 2
Abstract
Introduction:Medical devices used in Pediatric Intensive Care Units (PICU) are mostly made of plastic containing plasticizers that can leach out into the blood. We conducted a pilot study to assess exposure to phthalates in PICU. Methods:Phthalates metabolites levels were measured in urine of critically ill children at admission and Day 4. Plastic medical equipment required for each patient was also recorded. Results: All sixteen patients had high levels of phthalates metabolites in urine and infants had higher levels than adolescents. Despite plastic exposures, no increase in phthalates metabolites between admission and day 4 was observed. Conclusion: Children in PICU have a high degree of phthalates exposure Over the last 30 years, glass infusion containers were gradually replaced in intensive care units by plastic. However, unlike glass, these materials are not inert. More than 25% of all the plastics used in medical devices are made from polyvinyl chloride (PVC), a rigid product that is not easily malleable [1]. Plasticizers are added to PVC to make it flexible. Among the commercially available plasticizers, phthalates are the most commonly used. However, phthalates are not chemically bound to PVC and over time and use, they are released in the environment [2]. These synthetic chemical compounds have become ubiquitous in indoor and outdoor environments, in animals and in humans [3]. Of the 25 existing types of phthalates, di (2-ethylhexyl) phthalate (DEHP) is the only FDA-approved (US Food and Drug Administration) plasticizer in medical devices [4]. In intensive care units DEHP was detected in the following situations: i) Medical Devices: intubation tubes and circuits fan, digestive tubes, plastic gloves, central catheters made of PVC, dialysis circuit tubing, tubing of circulatory support (extracorporeal circulation (ECC) and extracorporeal membrane oxygenation (ECMO)); ii) Solute infusion liquids due to interaction between the plastic bags, tubing and some commonly used products such as: parenteral nutrition (especially intralipid), midazolam, fentanyl, blood products (red cell concentrate, platelets, fresh frozen plasma) [5,6]. While the average daily exposure to DEHP is estimated at 0.27 mg per day [1], the continuous exposure in intensive care units can result in an intake of 10 to 20 mg per day of DEHP [5]. The FDA has set a tolerable intake level of DEHP for parenteral exposure of 0.6 mg/kg/day [4]. However, the amount of phthalates released by medical devices does not appear to vary according to age groups, so that the dose of DEHP reported to the patient’s weight is greater as a child is younger, which explains that children are more vulnerable compared to adults [7]. Thus, the most exposed children to high doses of DEHP are those on life support, transfusion and under extracorporeal circulation [1]. Furthermore, an increase in body temperature appears to increase the amount of phthalates released from plastics [8].
Authors and Affiliations
William Davidson Urbain, Philippe Jouvet, Maria P Vélez, Pierre Ayotte, Patricia Monnier
Keywords
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- EP ID EP592313
- DOI 10.26717/BJSTR.2018.06.001322
- Views 177
- Downloads 0
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