Polyvinylchloride infusion lines expose infants to large amounts of toxic plasticizers.
OBJECTIVE
The purpose of this study was to evaluate whether infusion lines are able to leach plasticizers in substantial amounts and thus be a candidate substance for hepatotoxic effects during long-term total parenteral nutrition (TPN).


METHODS
TPN solutions, blood products, and selected drugs typical for preterm infants concerning amount, content, and infusion time were perfused through common polyvinylchloride (PVC) infusion lines. Concentration of diethylhexyl-phthalate (DEHP) before and after perfusion was determined by gas chromatography/mass spectrometry.


RESULTS
Daily quantities of DEHP by 24-hour infusions were Lipid emulsion 20%: 10185.6 microg; aminoacid/glucose-solution: 116.2 microg; midazolaminfusion for sedation: 26.4 microg; fentanyl for sedation: 132.5 microg; propofol for sedation: 6561.0 microg. The amount of DEHP by single doses of blood products (20 mL) were packed red blood cells: 144-608 microg; platelet rich plasma: 928 microg; and fresh frozen plasma: 552-8108 microg. The dose of DEHP for a typical preterm neonate requiring TPN and additional therapy like sedation or blood products is at minimum 10 mg and can easily reach 20 mg/d.


CONCLUSIONS
This large amount of DEHP is especially disturbing, because it effects the most vulnerable patients (neonates). Whether there is a relation to TPN-induced hepatobiliary dysfunction remains to be elucidated and is under investigation. With respect to recent literature, a biological effect of these doses must be assumed.
Loff
S
S
Departments of Pediatric Surgery and Pediatrics, Fakultät für Klinische Medizin Mannheim der Universität Heidelberg, Mannheim, Germany.
Kabs
F
F
Witt
K
K
Sartoris
J
J
Mandl
B
B
Niessen
K H
KH
Waag
K L
KL
D004051:Diethylhexyl Phthalate; D006801:Humans; D007260:Infusion Pumps; D010289:Parenteral Nutrition, Total; D011145:Polyvinyls
D011145:Polyvinyls; C003080:poly(vinyl chloride)-poly(vinyl acetate) copolymer; D004051:Diethylhexyl Phthalate