title: A review of alternatives to di (2-ethylhexyl) phthalate-containing medical devices in the neonatal intensive care unit.
abstract: OBJECTIVE
  To conduct an extensive literature and toxicological database review on substitute compounds and available alternative medical products to replace polyvinyl chloride (PVC) and/or di(2-ethylhexyl) phthalate (DEHP), and conduct a DEHP-medical inventory analysis at a large metropolitan neonatal intensive care unit (NICU).
  
  
  METHODS
  A systematic search for DEHP-free alternative products was performed using online databases. An informal audit of a large metropolitan NICU was undertaken in 2005 and 2006; 21 products were identified that could potentially contain DEHP. Availability of DEHP-free alternatives was determined through company websites and phone interviews.
  
  
  RESULTS
  Two alternative approaches are available for replacing DEHP in NICU medical products: (1) replacement by DEHP-free plasticizers; and (2) replacement of PVC entirely through the use of other polymers. Both approaches seem to provide less harmful substitutes to DEHP, but support PVC-free polymers as the preferred alternative. However, significant data gaps exist, particularly for the alternative polymers. In all, 10 out of 21 (48%) products in the NICU audit were DEHP-free; six consisted of alternative polymers and four of alternative plasticizers. Of the remaining 11 products, only three were available without DEHP at the time of the audit.
  
  
  CONCLUSIONS
  Because of significant data gaps, systematic toxicological testing of DEHP-free alternatives is imperative. Continued development of alternative products is also needed.
authors.affiliation: Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY 10032, USA. ev2117@columbia.edu
authors.forename: E D S
authors.initials: ED
authors.lastname: Van Vliet
authors.forename: E M
authors.initials: EM
authors.lastname: Reitano
authors.forename: J S
authors.initials: JS
authors.lastname: Chhabra
authors.forename: G P
authors.initials: GP
authors.lastname: Bergen
authors.forename: R M
authors.initials: RM
authors.lastname: Whyatt
mesh_terms: D001565:Benzoates; D004051:Diethylhexyl Phthalate; D004867:Equipment Design; D004869:Equipment Safety; D004865:Equipment and Supplies, Hospital / Q000009:adverse effects / Q000706:statistics & numerical data; D006801:Humans; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data; D010968:Plasticizers; D020959:Polyethylene; D011140:Polyurethanes; D012828:Silicones
chemical_list: D001565:Benzoates; D010968:Plasticizers; D011140:Polyurethanes; D012828:Silicones; C036101:tri-(2-ethylhexyl)trimellitate; D020959:Polyethylene; D004051:Diethylhexyl Phthalate