title: Extraction of the plasticizers diethylhexylphthalate and polyadipate from polyvinylchloride nasogastric tubes through gastric juice and feeding solution.
abstract: OBJECTIVE
  Except for polyadipate, which is used as an alternative in polyvinylchloride (PVC) feeding tubes, diethylhexylphthalate (DEHP) is the plasticizer used almost exclusively in PVC medical products. A clear response to the chronic intake of DEHP has been shown in several organ systems from different species. In the present study, we compared the extraction of DEHP and polyadipate from PVC gastric tubes.
  
  
  METHODS
  An in vivo setting was simulated. We used 5 cm of PVC nasogastric tubes containing DEHP or polyadipate, which were incubated with gastric juice for 1 week and a feeding solution for 4 weeks. The leakage of these plasticizers was measured daily in the gastric juice group and weekly in the feeding solution group. The amount of plasticizer extracted was compared between groups and days.
  
  
  RESULTS
  In the feeding solution group, the extraction of DEHP ranged from 200 to 542 microg after 1 week and from 660 to 1700 microg after 4 weeks. The extraction of polyadipate was 10 times lower than that of DEHP. In the gastric juice group, extracted DEHP ranged from 635 to 1043 microg, whereas the extraction of polyadipate was 100 times lower.
  
  
  CONCLUSIONS
  Within 1 week, the extraction of DEHP from a 5-cm PVC tube reaches up to 1 mg. Extrapolated, this represents an in vivo load of up to 4 mg. The load accumulated by a newborn in an intensive care unit can therefore easily reach several milligrams of DEHP per day. Polyadipate nasogastric tubes may therefore be an alternative and help to reduce the daily load of DEHP.
authors.affiliation: University Clinic of Pediatric Surgery Mannheim, Germany. ulrike.subotic@kch.ma.uni-heidelberg.de
authors.forename: Ulrike
authors.initials: U
authors.lastname: Subotic
authors.forename: Torsten
authors.initials: T
authors.lastname: Hannmann
authors.forename: Matthias
authors.initials: M
authors.lastname: Kiss
authors.forename: Joachim
authors.initials: J
authors.lastname: Brade
authors.forename: Katja
authors.initials: K
authors.lastname: Breitkopf
authors.forename: Steffan
authors.initials: S
authors.lastname: Loff
mesh_terms: D000272:Adipates / Q000737:chemistry; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004051:Diethylhexyl Phthalate / Q000032:analysis*; D004750:Enteral Nutrition; D005750:Gastric Juice / Q000737:chemistry*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007441:Intubation, Gastrointestinal; D010968:Plasticizers; D011108:Polymers / Q000737:chemistry; D011143:Polyvinyl Chloride
chemical_list: D000272:Adipates; D010968:Plasticizers; D011108:Polymers; C029900:adipic acid; D011143:Polyvinyl Chloride; D004051:Diethylhexyl Phthalate