Abstract

Plasticizers, used to increase the flexibility of plastic materials, can leach into the environment and the human body. Various adverse health effects are attributed to exposure to plasticizers, particularly phthalates. Premature newborns admitted to a neonatal intensive care unit (NICU) are exposed to many indwelling plastic devices containing plasticizers while in a developmentally vulnerable period. This is the first comprehensive review of its kind, providing an overview of DEHP and alternative plasticizers (APs), their sources and degree of exposure in the NICU, and the resulting health risks in (premature) infants. Despite the 2017 EU Medical Devices Regulation (2017/745), di-(2-ethylhexyl) phthalate (DEHP) is still a commonly present plasticizer in plastic medical devices in the NICU, with current labeling being insufficient to guarantee absence. Estimated NICU exposures remain elevated above the tolerable daily intake. Medical procedures leading to the highest exposure of phthalates and APs, are extracorporeal membrane oxygenation, blood transfusion, parenteral nutrition and respiratory support. As traditional matrices, such as blood and urine, are not always readily available in neonates, the accumulation of plasticizers in alternative matrices, such as hair and nails, provides an opportunity to study long-term accumulation of toxic chemicals. Impaired respiratory and neurodevelopment correlate with phthalate exposure at both biological and epidemiological levels in childhood, yet knowledge gaps about the effects in neonates prevail. Some APs provide interesting opportunities to reduce toxicity, but human data regarding health effects remain limited. Although toxicologists and regulators have addressed the problem for some time, awareness is lacking mainly among healthcare professionals.

摘要

用于增加塑料材料柔韧性的增塑剂会渗入环境和人体中。各种不良健康影响归因于接触增塑剂，特别是邻苯二甲酸盐。入住新生儿重症监护病房 (NICU) 的早产儿在发育脆弱时期会接触到许多含有增塑剂的内置塑料装置。这是同类产品中的第一篇综合综述，概述了 DEHP 和替代增塑剂 (AP)、它们在 NICU 中的来源和暴露程度，以及由此对（早产）婴儿造成的健康风险。尽管有 2017 年欧盟医疗器械法规 (2017/745)，邻苯二甲酸二（2-乙基己基）酯 (DEHP) 仍然是新生儿重症监护室塑料医疗器械中常见的增塑剂，目前的标签不足以保证缺席。估计的新生儿重症监护室暴露量仍然高于可耐受的每日摄入量。导致邻苯二甲酸盐和 AP 暴露量最高的医疗程序是体外膜氧合、输血、肠外营养和呼吸支持。由于新生儿体内并不总是容易获得血液​​和尿液等传统基质，因此增塑剂在头发和指甲等替代基质中的积累为研究有毒化学物质的长期积累提供了机会。呼吸和神经发育受损与儿童时期在生物学和流行病学水平上接触邻苯二甲酸盐有关，但关于新生儿影响的知识差距普遍存在。一些 AP 提供了降低毒性的有趣机会，但有关健康影响的人类数据仍然有限。尽管毒理学家和监管机构已经解决了一段时间的问题，但主要是医疗保健专业人员缺乏认识。