Plasticizers in Medical Devices Could Lead to Neurocognitive Deficits

Phthalates used to soften plastic tubes, catheters, and other medical devices can seep into a child's bloodstream and adversely affect long- term attention deficits, claims a new study.

Researchers at Katholieke Universiteit Leuven (KU; Belgium) and the University of Antwerp (Belgium) conducted a study involving 449 children who received treatment in a pediatric intensive care unit (PICU) and who underwent neurocognitive testing four years later. The researchers measured blood levels of Di(2-ethylhexyl)phthalate (DEHP) metabolites, initially performing the blood tests in 100 healthy children and in 228 of the PICU patients, who had one to 12 medical tubes in the PICU and whose age ranged from newborn to 16 years.

The researchers found that DEHP metabolite levels were not detectable in blood samples of healthy children. Catheterized critically ill children admitted to the PICU, however, had extremely high levels of DEHP that—although decreasing rapidly—remained 18 times higher until discharge from the PICU. High exposure to DEHP during the PICU stay was also strongly associated with attention deficit found at neurocognitive testing four years after discharge. The finding was validated in a different group of 221 PICU patients. The study was published in the March 2016 issue of Intensive Care Medicine.

“Phthalates have been banned from children’s toys because of their potential toxic and hormone disrupting effects, but they are still used to soften medical devices,” said lead author Sören Verstraete, MD, a PhD student at KU. “We found a clear match between previously hospitalized children’s long-term neurocognitive test results and their individual exposure to the phthalate DEHP during intensive care. This phthalate exposure explained half of the attention deficit in former PICU patients.”

DEHP is a general-purpose phthalate plasticizer for softening polyvinyl chloride (PVC). It has been used for softening medical devices such as intravenous tubing and bags, IV catheters, nasogastric tubes, dialysis bags and tubing, blood bags and transfusion tubing, and air tubes for over 50 years. DEHP is readily absorbed and distributed in the body, but is considered to be not persistent or bioaccumulative, and is classified as readily biodegradable.

Related Links:
Katholieke Universiteit Leuven
University of Antwerp