title: Di-(2-ethylhexyl)phthalate leakage and color changes in endotracheal tubes after application in high-risk newborns.
abstract: BACKGROUND
  Polyvinylchloride (PVC) is often adopted for making medical devices.
  
  
  OBJECTIVE
  Testing the hypothesis that materials degradation occurs in PVC endotracheal tubes during infant ventilation, thus releasing the known toxic plasticizer di-(2-ethylhexyl)phthalate (DEHP).
  
  
  METHODS
  Endotracheal tubes degradation was assessed by: (1) analysis of color and spectral changes in endotracheal tubes after use in the 400- to 700-nm range and compared to virgin samples. Color changes were expressed as euclidean distances in the Commission International de l'Eclairage Laboratory and Lightness-Chroma-Hue (Munsell's) color spaces (i.e., Delta E, Delta L, Delta a, Delta b, Delta C, and Delta H units); (2) DEHP leakage was assessed by thermal characterization by differential scanning calorimetry (DSC) and thermal gravimetric analysis (TGA). Data from used tubes were compared with those from either virgin devices or submitted to artificial aging, including O(2)-induced oxidation, washing, UV photodegradation and exposition to acid solutions.
  
  
  RESULTS
  Significant color differences of 13.33 +/- 0.85 Delta E were evidenced in used endotracheal tubes, as compared to virgin samples (p < 0.0001). Chromatic changes were independent from intubation duration. DSC and TGA analyses showed a loss of DEHP from used tubes, as indicated by increase of the glass transition temperature (Tg) and DEHP weight loss. In vivo application of tubes was associated with an aging process whose effects on the optical and spectral properties were similar to those observed following artificial aging processes.
  
  
  CONCLUSIONS
  Our findings indicate that significant spectrocolorimetric, DSC and TGA changes occur in endotracheal tubes after application, thus demonstrating for the first time the occurrence of in vivo materials degradation and DEHP leakage from medical devices worldwide used for neonatal ventilation.
authors.affiliation: Division of Neonatology, A. Perrino Hospital, Brindisi, Italy. gilatini@tin.it
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Latini
authors.forename: Claudio
authors.initials: C
authors.lastname: De Felice
authors.forename: Antonio
authors.initials: A
authors.lastname: Del Vecchio
authors.forename: Alessandro
authors.initials: A
authors.lastname: Barducci
authors.forename: Marcella
authors.initials: M
authors.lastname: Ferri
authors.forename: Federica
authors.initials: F
authors.lastname: Chiellini
mesh_terms: D002152:Calorimetry, Differential Scanning; D003116:Color; D003124:Colorimetry; D004051:Diethylhexyl Phthalate; D004055:Differential Thermal Analysis; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007442:Intubation, Intratracheal / Q000295:instrumentation*; D008297:Male; D008422:Materials Testing / Q000379:methods*; D010968:Plasticizers; D011143:Polyvinyl Chloride; D012122:Ventilators, Mechanical
chemical_list: D010968:Plasticizers; D011143:Polyvinyl Chloride; D004051:Diethylhexyl Phthalate