title: Exposure to di(2-ethylhexyl) phthalate in premature neonates in a neonatal intensive care unit in Taiwan.
abstract: OBJECTIVE
  Neonates are exposed to high levels of di(2ethylhexyl) phthalate through numerous medical procedures in the neonatal intensive care unit. Our aim was to assess the contribution of specific medical devices to the di(2-ethylhexyl) phthalate exposure of neonates.
  
  
  METHODS
  Prospective.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  We recruited 32 premature neonates, 20 with very low birth weight (<1500 g) and 12 with low birth weight (<2500 g), and 31 controls at a neonatal intensive care unit from a medical center in central Taiwan.
  
  
  METHODS
  Interventions were based on a clinical need and used standard materials and devices, including endotracheal tubes, continuous positive airway pressure, oxygen hood, intravenous injection, intralipid injection, blood transfusion, orogastric tubes, nasogastric tubes, umbilical venous catheterization, umbilical arterial catheterization, chest tube, and isolate.
  
  
  RESULTS
  We recorded the medical procedures of each subject, collected their urine samples, and determined the urinary concentration of three metabolites of di(2-ethylhexyl) phthalate using reversed-phase high-performance liquid chromatography-atmospheric pressure chemical ionization-tandem mass spectrometry. Median levels of di(2-ethylhexyl) phthalate metabolites in premature neonates treated with an endotracheal tube and orogastric tube or nasogastric tube were significantly higher than those not treated with an endotracheal tube, orogastric tube, or nasogastric tube. Median levels of di(2-ethylhexyl) phthalate metabolites in premature neonates treated with intravenous injection were ≥ 2-fold higher than those of healthy controls who received intravenous injections (p = .01). Median levels of three di(2-ethylhexyl) phthalate metabolites were similar in very-low-birth-weight and low-birth-weight neonates.
  
  
  CONCLUSIONS
  These data suggest that polyvinyl chloride-containing devices are the major defining factor in di(2-ethylhexyl) phthalate exposure levels in neonates in the neonatal intensive care unit. We urge the use of polyvinyl chloride-free or alternative materials in medical devices, especially for endotracheal tubes, orogastric tubes, nasogastric tubes, and intravenous tubing in the neonatal intensive care unit. The health effects of high di(2-ethylhexyl) phthalate exposure on premature neonates in the neonatal intensive care unit is worthy of further investigation.
authors.affiliation: Division of Genetics, Department of Pediatrics, Chung Shan Medical University Hospital, Zhunan, Taiwan.
authors.forename: Pen-Hua
authors.initials: PH
authors.lastname: Su
authors.forename: Yan-Zin
authors.initials: YZ
authors.lastname: Chang
authors.forename: Hua-Pin
authors.initials: HP
authors.lastname: Chang
authors.forename: Shu-Li
authors.initials: SL
authors.lastname: Wang
authors.forename: Hsin-I
authors.initials: HI
authors.lastname: Haung
authors.forename: Po-Chin
authors.initials: PC
authors.lastname: Huang
authors.forename: Jia-Yuh
authors.initials: JY
authors.lastname: Chen
mesh_terms: D015415:Biomarkers / Q000652:urine; D001724:Birth Weight; D002406:Catheterization, Peripheral / Q000295:instrumentation; D004051:Diethylhexyl Phthalate / Q000031:analogs & derivatives* / Q000378:metabolism / Q000652:urine*; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature / Q000378:metabolism; D019102:Infant, Very Low Birth Weight / Q000378:metabolism; D007363:Intensive Care Units, Neonatal; D007441:Intubation, Gastrointestinal / Q000295:instrumentation; D007442:Intubation, Intratracheal / Q000295:instrumentation; D008297:Male; D010795:Phthalic Acids / Q000652:urine*; D011143:Polyvinyl Chloride / Q000378:metabolism; D011446:Prospective Studies; D013624:Taiwan
chemical_list: D015415:Biomarkers; D010795:Phthalic Acids; C479069:mono(2-ethyl-5-hydroxyhexyl) phthalate; C080276:mono(2-ethyl-5-oxohexyl)phthalate; D011143:Polyvinyl Chloride; D004051:Diethylhexyl Phthalate; C016599:mono-(2-ethylhexyl)phthalate