Polyvinylchloride infusion lines expose infants to large amounts of toxic plasticizers

Purpose: The purpose of this study was to evaluate whether infusion lines are able to leach plasticizers in substantial amounts and thus be a candidate substance for hepatotoxic effects during long-term total parenteral nutrition (TPN). Methods: TPN solutions, blood products, and selected drugs typical for preterm infants concerning amount, content, and infusion time were perfused through common polyvinylchloride (PVC) infusion lines. Concentration of diethylhexylphthalate (DEHP) before and after perfusion was determined by gas chromatography/mass spectrometry. Results: Daily quantities of DEHP by 24-hour infusions were Lipid emulsion 20%: 10185.6 mug; aminoacid/glucose-solution: 116.2 mug; midazolaminfusion for sedation: 26.4 mug; fentanyl for sedation: 132.5 mug; propofol for sedation: 6561.0 mug. The amount of DEHP by single doses of blood products (20 mL) were packed red blood cells: 144-608 mug; platelet rich plasma: 928 mug; and fresh frozen plasma: 552-8108 mug. The dose of DEHP for a typical preterm neonate requiering TPN and additional therapy like sedation or blood products is at minimum 10 mg and can easily reach 20 mg/d. Conclusion: This large amount of DEHP is especially disturbing, because it effects the most vulnerable patients (neonates). Whether there is a relation to TPN-induced hepatobiliary dysfunction remains to be elucidated and is under investigation. With respect to recent literature, a biological effect of these doses must be assumed. J Pediatr Surg 35:1775-1781. Copyright (C) 2000 by W.B. Saunders Company.