title: Use of di(2-ethylhexyl)phthalate-containing infusion systems increases the risk for cholestasis.
abstract: BACKGROUND
  Most polyvinylchloride infusion systems are plasticized with up to 60% of di(2-ethylhexyl)phthalate (DEHP). DEHP is easily extracted from the tubing by total parenteral nutrition (TPN) solutions and has been shown to have toxic effects on various organ systems including the liver in animals and humans. A role was postulated for DEHP in the development of hepatobiliary dysfunction in premature and newborn infants receiving parenteral nutrition, and the incidence of cholestasis was investigated after changing from polyvinylchloride infusion systems to polyvinylchloride-free infusion systems.
  
  
  METHODS
  Two 3-year periods from 1998 to 2004 were investigated retrospectively before and after changing from polyvinylchloride to polyvinylchloride-free infusion systems in our department. This resulted in 1 group of 30 patients treated with polyvinylchloride lines and a second group of 46 patients treated with polyvinylchloride-free lines. The 2 groups were examined for the incidence of cholestasis and other possible contributing factors. Statistics were performed by using SAS software (SAS Institute, Cary, NC).
  
  
  RESULTS
  After changing infusion systems, the incidence of cholestasis dropped from 50% to 13%. Using DEHP-plasticized polyvinylchloride infusion systems for TPN increased the risk for cholestasis by a factor of 5.6. The use of polyvinylchloride lines correlated strongly with the development of TPN-associated cholestasis (P = .0004).
  
  
  CONCLUSIONS
  Using DEHP-containing polyvinylchloride infusions systems contributes to the development of cholestasis. Therefore, the use of DEHP-free infusion systems for TPN is recommended, especially in premature and newborn infants.
authors: Department of Pediatric Surgery, University Hospital Mannheim, Mannheim, Germany. heike.vonrettberg@kch.ma.uni-heidelberg.de
authors: Heike
authors: H
authors: von Rettberg
authors: Torsten
authors: T
authors: Hannman
authors: Ulrike
authors: U
authors: Subotic
authors: Joachim
authors: J
authors: Brade
authors: Thomas
authors: T
authors: Schaible
authors: Karl Ludwig
authors: KL
authors: Waag
authors: Steffan
authors: S
authors: Loff
mesh_terms: D001663:Bilirubin / Q000097:blood; D002779:Cholestasis / Q000097:blood / Q000139:chemically induced* / Q000453:epidemiology; D003430:Cross-Sectional Studies; D004051:Diethylhexyl Phthalate / Q000633:toxicity*; D005217:Fat Emulsions, Intravenous / Q000008:administration & dosage; D005260:Female; D005858:Germany; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000097:blood / Q000139:chemically induced* / Q000453:epidemiology; D007260:Infusion Pumps; D007363:Intensive Care Units, Neonatal; D008111:Liver Function Tests; D008297:Male; D016017:Odds Ratio; D010289:Parenteral Nutrition, Total / Q000295:instrumentation*; D010968:Plasticizers / Q000633:toxicity*; D011143:Polyvinyl Chloride / Q000633:toxicity*; D012189:Retrospective Studies; D013223:Statistics as Topic
chemical_list: D005217:Fat Emulsions, Intravenous; D010968:Plasticizers; D011143:Polyvinyl Chloride; D004051:Diethylhexyl Phthalate; D001663:Bilirubin