Our Stolen Futurea book by Theo Colborn, Dianne Dumanoski, and John Peterson Myers


  Green, R, R Hauser, AM Calafat, J Weuve, T Schettler, S Ringer, K Huttner, and H Hu. 2005. Use of di(2-ethylhexyl) phthalate containing medical products and urinary levels of mono(2-ethylhexyl) phthalate in neonatal intensive care unit infants. Environmental Health Perspectives, in press.

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Green et al. report that use in neonatal intensive care units of medical products containing the phthalate DEHP results in higher levels of exposure. Infants in the highest exposure group carried levels of DEHP's metabolite, MEHP, that were 5 times higher than infants in the lowest exposure group.

This study confirms that use of PVC products containing DEHP in neonatal intensive care units leads to significant exposure to a contaminant known to adversely affect development in animals.

PVC plastics are commonly used in hospital equipment, for example, tubing used to deliver fluids (e.g., IV or feeding) and blood storage bags.

The medical significance of these results for infants are unknown. While the animal data are unequivocal in demonstrating adverse effects, only one small study has examined impacts on human infants.


What did they do? Green et al. observed infant care in two neonatal intensive care units in Boston, MA, hospitals. Their observations, which included recording the use of equipment made of DEHP-containing PVC plastic, allowed them to categorize each infant's exposure as 'light,' 'medium,' or 'heavy.'

They obtained urine samples from the infants diapers; these were analyzed for MEHP levels by the US Centers for Disease Control chemistry laboratory.

They then examined the relationship between exposure category and MEHP level in urine.


What did they find? Their sample included 34 infant girls and 20 infant boys. Thirteen were classified as low exposure to DEHP, 24 medium and 17 high.

As shown in the figure to the right, urinary MEHP level was strongly related to exposure group: the more DEHP exposure, the higher the level of MEHP in urine. Levels in the high exposure group were 5.1 times higher than those in the low exposure group.

When they took repeat measurements from the same baby, the results were very similar.


They also found a significant difference between the hospitals in the levels of phthalates observed in the urine. This difference was highly significant (p = 0.002). They suggest this difference was a result of 'sparing use' by one of the hospitals of two specific types of DEHP-containing medical equipment, "unsiliconised PVC indwelling endotracheal tubes, and a PVC indwelling umbilical vessel hemodynamic monitoring catheter used for, among other things, parenteral nutrition."

Levels were higher in male infants than in female infants.

What does it mean? The choice of equipment made by hospitals can dramatically reduce DEHP exposure in neonatal intensive care units. According to coverage in the Los Angeles Times, the hospital with lower DEHP exposure had switched to equipment that was not made from PVC-based plastics, which contain DEHP: " In the study, significantly lower phthalate levels were found in the urine of babies at the hospital that had switched to some DEHP-free devices."

The exposure levels measured in these infants were higher than those demonstrated to cause developmental harm in rodents. Recent work has suggested, however, that humans may be more sensitive to phthalates than rodents. This remains to be resolved.





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