Association between Urinary Metabolites and the Exposure of Intensive Care Newborns to Plasticizers of Medical Devices Used for Their Care Management

Care management of newborns in the neonatal intensive care unit (NICU) requires numerous PVC (PolyVinyl Chloride) medical devices (MD) containing plasticizers that can migrate and contaminate the patient. We measured the magnitude of neonates’ exposure to plasticizers (di-ethylhexylphthalate (DEHP) and alternatives) in relation to urinary concentrations of their metabolites. Plasticizers’ exposure was evaluated (1) by calculating the amounts of plasticizers prone to be released from each MD used for care management, and (2) by measuring the patients’ urinary levels of each plasticizers’ metabolites. 104 neonates were enrolled. They were exposed to di-isononylphthalate (DINP), especially via transfusion and infusion MD, and to DEHP via ECMO (Extra Corporeal Membrane Oxygenation) and respiratory assistance MD. Mean exposure doses exceeded the derived no-effect level of DINP and DEHP by a 10-fold and a 1000-fold factor. No PVC MD were plasticized with di-isononylcyclohexane-1,2-dicarboxylate (DINCH). High urinary concentrations of DEHP metabolites were directly correlated with DEHP exposure through ECMO MD. Urinary concentrations of DINP metabolites in transfused patients were also high. DINCH metabolites were found in urine, suggesting another route of exposure. Neonates in NICU are considerably exposed to plasticizers, with magnitudes varying with the type of MD used. The high exposure to DEHP and DINP leads to a risk of their metabolites’ toxicity.

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Reply to Otter et al. Comment on “Bernard et al. Association between Urinary Metabolites and the Exposure of Intensive Care Newborns to Plasticizers of Medical Devices Used for Their Care Management. Metabolites 2021, 11, 252”

Metabolites ◽

10.3390/metabo11090598 ◽

2021 ◽

Vol 11 (9) ◽

pp. 598

Author(s):

Lise Bernard ◽

Yassine Bouattour ◽

Morgane Masse ◽

Benoît Boeuf ◽

Bertrand Decaudin ◽

...

Keyword(s):

Intensive Care ◽

Medical Devices ◽

Care Management ◽

Urinary Metabolites

The comments written by R. Otter et al. [...]

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How to Reduce DEHP in Your NICU: A Plan of Simple Steps to Promote Change

Neonatal Network The Journal of Neonatal Nursing ◽

10.1891/0730-0832.25.6.447 ◽

2006 ◽

Vol 25 (6) ◽

pp. 447-449 ◽

Cited By ~ 11

Author(s):

Victoria Pak ◽

Valerie Briscoe ◽

Linda McCauley

Keyword(s):

Public Health ◽

Intensive Care Unit ◽

Intensive Care ◽

Medical Devices ◽

Neonatal Intensive Care ◽

Neonatal Nurses ◽

Neonates And Infants ◽

Ethylhexyl Phthalate ◽

Dehp Exposure ◽

The U.S

IN THEIR EFFORTS TO IMPROVE THE health outcomes of neonates and infants in the Neonatal Intensive Care Unit (NICU), neonatal nurses should understand the potential for harm that plastic medical devices pose to infants. Di(2-ethylhexyl) phthalate (DEHP) is a plasticizer used to soften polyvinylchloride (PVC) that can leach from the plastic into the fluid or gas being delivered to the neonate. DEHP can harm the developing reproductive system. The U.S. Food and Drug Administration (FDA) has issued a public health notification recommendation that DEHP- free devices be considered for use in NICU patients.1 There are alternatives available. The purpose of this column is to inform neonatal nurses of the risk of DEHP exposure among infants and to make it simpler for them to implement change in reducing DEHP in their institution.

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Comment on Bernard et al. Association between Urinary Metabolites and the Exposure of Intensive Care Newborns to Plasticizers of Medical Devices Used for Their Care Management. Metabolites 2021, 11, 252

Metabolites ◽

10.3390/metabo11090596 ◽

2021 ◽

Vol 11 (9) ◽

pp. 596

Author(s):

Rainer Otter ◽

Angelika Langsch ◽

Patrick Harmon ◽

Scott C. Boito ◽

Jan Mervart ◽

...

Keyword(s):

Intensive Care ◽

Medical Devices ◽

Care Management ◽

Urinary Metabolites

The recent publication “Association between Urinary Metabolites and the Exposure of Intensive Care Newborns to Plasticizers of Medical Devices Used for Their Care Management” by L. Bernard et al. (2021) [...]

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Adoption of medical devices: Perspectives of professionals in Swedish neonatal intensive care

Technology and Health Care ◽

10.3233/thc-2007-15301 ◽

2007 ◽

Vol 15 (3) ◽

pp. 157-179 ◽

Cited By ~ 9

Author(s):

Kerstin Roback ◽

Per-Olof Gäddlin ◽

Nina Nelson ◽

Jan Persson

Keyword(s):

Intensive Care ◽

Medical Devices ◽

Neonatal Intensive Care

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Successful Infection Control of an Extended-Spectrum Beta-Lactamase-Producing Klebsiella pneumoniae ST307 Outbreak in a Neonatal Intensive Care Unit

10.21203/rs.2.16751/v1 ◽

2019 ◽

Author(s):

Eun-Hwa Baek ◽

Se-Eun Kim ◽

Sunjoo Kim ◽

Seungjun Lee ◽

Oh-Hyun Cho ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Klebsiella Pneumoniae ◽

Infection Control ◽

Medical Devices ◽

Neonatal Intensive Care ◽

Medical Personnel ◽

Beta Lactamase ◽

Clinical Specimens ◽

Extended Spectrum Beta Lactamase

Abstract Background : We experienced an outbreak of extended-spectrum-beta-lactamase-producing Klebsiella pneumoniae (ESBL-KPN) bacteremia in a neonatal intensive care unit (NICU) starting in August 2017. We implemented an active countermeasure to control the outbreak of ESBL-KPN successfully. Methods: The incidence of ESBL-KPN based on clinical specimens and healthcare-associated infection (HAI) rate were evaluated before and after the initiation of enhanced infection control (IC) practices initiated in January, 2018. Surveillance cultures were carried out for neonates, medical personnel, and NICU environmental samples. Molecular analyses, including pulse-field gel electrophoresis (PFGE), sequence typing, and ESBL genotyping, were performed for the isolated KPN strains. Results: The incidence of ESBL-KPN in clinical specimens decreased from 2.84 to 0.49 per 1,000 patient-days and the HAI rate decreased from 2.43 to 0.0 per 1,000 patient-days after the implementation of enhanced IC procedures. Eleven neonates (11/15, 73.3%), one (1/41, 2.4%) of the medical personnel, and six (6/181, 3.3%) samples from the surroundings and medical devices were positive for ESBL-KPN in the surveillance cultures. All isolates demonstrated the same antibiotic resistance pattern and similar PFGE patterns and were identified as ST307 containing CTX-M-15. Conclusions: Contaminated neonate surroundings and medical devices as well as spreading by medical personnel appeared to be the source of the outbreak of ESBL-KPN. We used an enhanced IC strategy for 3 months and successfully resolved the clonal outbreak of CTX-M-15-producing KPN. ST307 has emerged as an important bacteremia-causing pathogen in the NICU and should be monitored carefully.

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