Division of Genetics, Department of Pediatrics, Chung Shan Medical University Hospital, Zhunan, Taiwan.
Pediatr Crit Care Med. 2012 Nov;13(6):671-7. doi: 10.1097/PCC.0b013e3182455558.
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.
Prospective.
University hospital.
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.
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.
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.
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.
新生儿在新生儿重症监护病房（NICU）中会通过多种医疗程序接触到高水平的邻苯二甲酸二（2-乙基己基）酯（DEHP）。我们的目的是评估特定医疗设备对新生儿 DEHP 暴露的贡献。
前瞻性。
大学医院。
我们招募了 32 名早产儿，其中 20 名极低出生体重（<1500g），12 名低出生体重（<2500g），以及 31 名来自台湾中部一家医疗中心的 NICU 的对照组。
干预措施基于临床需求，并使用标准材料和设备，包括气管内管、持续气道正压通气、氧气罩、静脉注射、脂肪乳剂注射、输血、经口胃管、经鼻胃管、脐静脉置管、脐动脉置管、胸腔引流管和隔离器。
我们记录了每位受试者的医疗程序，收集了他们的尿液样本，并使用反相高效液相色谱-大气压化学电离-串联质谱法测定了三种 DEHP 代谢物的尿浓度。接受气管内管和经口胃管或经鼻胃管治疗的早产儿的 DEHP 代谢物中位数水平明显高于未接受气管内管、经口胃管或经鼻胃管治疗的早产儿。接受静脉注射治疗的早产儿的 DEHP 代谢物中位数水平是接受静脉注射的健康对照组的 2 倍以上（p =.01）。极低出生体重和低出生体重早产儿的三种 DEHP 代谢物中位数水平相似。
这些数据表明，含聚氯乙烯的设备是新生儿重症监护病房中 DEHP 暴露水平的主要决定因素。我们敦促在医疗设备中使用不含聚氯乙烯或替代材料，特别是在新生儿重症监护病房中的气管内管、经口胃管、经鼻胃管和静脉注射管中。新生儿重症监护病房中高 DEHP 暴露对早产儿的健康影响值得进一步研究。
