title: Phthalates and critically ill neonates: device-related exposures and non-endocrine toxic risks.
abstract: OBJECTIVE
  To assess the types and magnitudes of non-endocrine toxic risks to neonates associated with medical device-related exposures to di(2-ethylhexyl)phthalate (DEHP).
  
  
  METHODS
  Dose-response thresholds for DEHP toxicities were determined from published data, as were the magnitudes of DEHP exposures resulting from neonatal contact with polyvinyl chloride (PVC) devices. Standard methods of risk assessment were used to determine safe levels of DEHP exposure in neonates, and hazard quotients were calculated for devices individually and in aggregate.
  
  
  RESULTS
  Daily intake of DEHP for critically ill preterm infants can reach 16 mg/kg per day, which is on the order of 4000 and 160,000 times higher than desired to avoid reproductive and hepatic toxicities, respectively. The non-endocrine toxicities of DEHP are similar to complications experienced by preterm neonates.
  
  
  CONCLUSIONS
  DEHP exposures in neonatal intensive care are much higher than estimated safe limits, and might contribute to common early and chronic complications of prematurity. Concerns about phthalates should be expanded beyond endocrine disruption.
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Risk Sciences and Public Policy Institute, Baltimore, MD, USA.
authors.forename: E B
authors.initials: EB
authors.lastname: Mallow
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Risk Sciences and Public Policy Institute, Baltimore, MD, USA.
authors.forename: M A
authors.initials: MA
authors.lastname: Fox
mesh_terms: D000818:Animals; D057785:Catheters; D002657:Child Development / Q000187:drug effects; D016638:Critical Illness; D004051:Diethylhexyl Phthalate / Q000009:adverse effects* / Q000633:toxicity; D004305:Dose-Response Relationship, Drug; D004750:Enteral Nutrition / Q000295:instrumentation; D004781:Environmental Exposure; D004864:Equipment and Supplies / Q000009:adverse effects*; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007363:Intensive Care Units, Neonatal; D007442:Intubation, Intratracheal / Q000295:instrumentation; D019055:No-Observed-Adverse-Effect Level; D010968:Plasticizers / Q000009:adverse effects* / Q000633:toxicity; D018570:Risk Assessment
chemical_list: D010968:Plasticizers; D004051:Diethylhexyl Phthalate