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Plastic Babies: The DEHP Dilemma

IV_Bag_shutterstock_171591929By Lawrence Rosen, MD. 11/20/15
DEHP (di-(2-ethylhexyl)phthalate) is a compound commonly found in plastic medical devices made from polyvinyl chloride (PVC).  This chemical has come under increased scrutiny with respect to the care of our most vulnerable children: critically ill newborns hospitalized in neonatal intensive care units (NICU’s). The incredibly sophisticated level of care found in the NICU saves the lives of thousands of premature babies every year, but it seems that the very equipment used to aid these infants may in fact be causing serious harm.

The FDA lists the following products commonly used in NICUs as containing DEHP:
 
- IV bags and tubing
- Umbilical artery catheters
- Blood bags and tubing
- Nasogastric feeding tubes
- Respiratory tubing
- Enteral nutrition feeding bags
 
Concerned by the widespread exposure of sick newborns to these devices, researchers at Johns Hopkins Bloomberg School of Public Health – as reported by NPR - “determined that a critically ill preemie hooked up to multiple tubes and devices containing DEHP could be exposed to 16 milligrams per kilogram of body weight a day of the chemical, which is 160,000 times higher than desired to avoid liver damage.”
 
Why would this be a concern?  For one, DEHP has been linked, per report by the U.S. Environmental Protection Agency (EPA), to endocrine disruption, birth defects, asthma and cancer in animal studies. Additionally, Dr. Eric Mallow, the lead researcher on the Hopkins report, notes, "DEHP and other phthalates are proinflammatory, and most of the injuries that preemies get are inflammatory in nature.”  A recent review of the adverse effects of DEHP and related phthalates on children’s health found that “fetal and childhood exposure to some phthalates may perturb normal development, with several studies consistently reporting increased risk of allergic diseases” and offered that “providers can counsel concerned patients to reduce phthalate exposures in order to protect the developing fetus and child from potential adverse health outcomes.”
 
In this spirit, some hospitals have tried to eliminate or reduce the use of phthalate-containing products.  However despite  best intentions, hospitals have been unable to replace DEHP in all areas including the NICU. Why? Because there is a shortage of  vendors able to supply alternative, theoretically safer products.  “Consistent supply is essential to getting hospitals to switch to DEHP-free products. Additionally, as more healthcare facilities create demand, the more manufacturers will respond,” comments Kyle Tafuri, Sustainability Advisor at Hackensack University Medical Center in New Jersey. 
 
Erin S. Ihde, MA, CCRP, researcher at the The Deirdre Imus Environmental Health Center at HackensackUMC, advises, “One of the keys to the success of DEHP-free medical products is having clinicians and administrators advocating for the change within their departments. It only takes one person to educate others and move the process forward.”
 
Does the benefit of current medical therapy in NICU’s outweigh the harm? While one would not advise abandoning the use of feeding tubes, IV’s, blood products and breathing tubes given their life-saving contributions, we should be concerned about the ongoing exposure of premature, critically ill babies to potentially toxic plasticizers.The theoretical, animal and preliminary human evidence linking DEHP and its metabolites to the disruption of hormonal and immunological pathways is deeply troubling.
 
Sadly, studies to evaluate the immediate and long-term impact of DEHP on babies’ endocrine, immune and neurological systems are lacking.  Under the precautionary principle guidelines, many environmental health scientists advocate for avoiding the use of any potential toxic chemicals until we can adequately insure human harm will not result from exposure. Yet, this is not the current regulatory environment in the United States. Too often, chemicals are introduced into mainstream use, even in the healthcare industry, without adequate proof of safety.  As we’ve previously noted, children in particular are quite vulnerable and are frequent victims of environmental injustice.  For the preservation of our children’s health, and our future, we must work together to adopt new integrative strategies to address the complex environmental challenges we now face.
 
dr_rosen_bio_pic_3-6-14Lawrence Rosen, MD is an integrative pediatrician and co-author of Treatment Alternatives for Children. He is the founder of the Whole Child Center, one of the country’s first green and integrative pediatric practices, and he serves as Medical Advisor to The Deirdre Imus Environmental Health Center.  Dr. Rosen’s academic credentials include positions as past Chair of the AAP Section on Integrative Medicine, Clinical Assistant Professor in Pediatrics at UMDNJ, and author of numerous articles and book chapters on integrative pediatrics. He is also the pediatric columnist for Kiwi Magazine and blogs for the Huffington Post. 
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