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A review of alternatives to di (2-ethylhexyl) phthalate-containing medical devices in the neonatal intensive care unit

Journal of Perinatology volume 31, pages 551–560 (2011)Cite this article

Subjects

A Corrigendum to this article was published on 30 July 2012

Abstract

Objective:

To conduct an extensive literature and toxicological database review on substitute compounds and available alternative medical products to replace polyvinyl chloride (PVC) and/or di(2-ethylhexyl) phthalate (DEHP), and conduct a DEHP-medical inventory analysis at a large metropolitan neonatal intensive care unit (NICU).

Study Design:

A systematic search for DEHP-free alternative products was performed using online databases. An informal audit of a large metropolitan NICU was undertaken in 2005 and 2006; 21 products were identified that could potentially contain DEHP. Availability of DEHP-free alternatives was determined through company websites and phone interviews.

Result:

Two alternative approaches are available for replacing DEHP in NICU medical products: (1) replacement by DEHP-free plasticizers; and (2) replacement of PVC entirely through the use of other polymers. Both approaches seem to provide less harmful substitutes to DEHP, but support PVC-free polymers as the preferred alternative. However, significant data gaps exist, particularly for the alternative polymers. In all, 10 out of 21 (48%) products in the NICU audit were DEHP-free; six consisted of alternative polymers and four of alternative plasticizers. Of the remaining 11 products, only three were available without DEHP at the time of the audit.

Conclusion:

Because of significant data gaps, systematic toxicological testing of DEHP-free alternatives is imperative. Continued development of alternative products is also needed.

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References

  1. Hauser R, Williams P, Altshul L, Calafat AM . Evidence of interaction between polychlorinated biphenyls and phthalates in relation to human sperm motility. Environ Health Perspect 2005; 113 (4): 425–430.

    Article  CAS  Google Scholar 

  2. Shea KM . Pediatric exposure and potential toxicity of phthalate plasticizers. Pediatrics 2003; 111 (6 Pt 1): 1467–1474.

    Article  Google Scholar 

  3. Gibson TP, Briggs WA, Boone BJ . Delivery of di-2-ethylhexyl phthalate to patients during hemodialysis. J Lab Clin Med 1976; 87 (3): 519–524.

    CAS  PubMed  Google Scholar 

  4. Jaeger RJ, Rubin RJ . Plasticizers from plastic devices extraction, metabolism, and accumulation by biological systems. Science 1970; 170 (956): 460–462.

    Article  CAS  Google Scholar 

  5. Jaeger RJ, Rubin RJ . Migration of a phthalate ester plasticizer from polyvinyl chloride blood bags into stored human blood and its localization in human tissues. N Engl J Med 1972; 287 (22): 1114–1118.

    Article  CAS  Google Scholar 

  6. Kambia K, Dine T, Gressier B, Bah S, Germe AF, Luyckx M et al. Evaluation of childhood exposure to di(2-ethylhexyl) phthalate from perfusion kits during long-term parenteral nutrition. Int J Pharm 2003; 262 (1-2): 83–91.

    Article  CAS  Google Scholar 

  7. Karbæk K . Evaluation of Plasticisers for PVC for Medical Devices. Danish EPA, Danish Technological Institute, Plastics Technology; Copenhagen, Denmark, 2003.

    Google Scholar 

  8. Lewis LM, Flechtner TW, Kerkay J, Pearson KH, Nakamoto S . Bis(2-ethylhexyl)phthalate concentrations in the serum of hemodialysis patients. Clin Chem 1978; 24 (5): 741–746.

    CAS  PubMed  Google Scholar 

  9. Loff S, Subotic U, Reinicke F, Wischmann H, Brade J . Extraction of Di-ethylhexyl-phthalate from perfusion lines of various material, length and brand by lipid emulsions. J Pediatr Gastroenterol Nutr 2004; 39 (4): 341–345.

    Article  CAS  Google Scholar 

  10. Peck CC, Odom DG, Albro PW, Jess DA, Barrett BB . Effect of heat on the conversion of di-2-ethylhexyl phthalate to mono-2-ethylhexyl phthalate in human plasma. Transfusion 1981; 21 (2): 163–166.

    Article  CAS  Google Scholar 

  11. Pollack GM, Buchanan JF, Slaughter RL, Kohli RK, Shen DD . Circulating concentrations of di(2-ethylhexyl) phthalate and its de-esterified phthalic acid products following plasticizer exposure in patients receiving hemodialysis. Toxicol Appl Pharmacol 1985; 79 (2): 257–267.

    Article  CAS  Google Scholar 

  12. Poon R, Lecavalier P, Mueller R, Valli VE, Procter BG, Chu I . Subchronic oral toxicity of di-n-octyl phthalate and di(2-Ethylhexyl) phthalate in the rat. Food Chem Toxicol 1997; 35 (2): 225–239.

    Article  CAS  Google Scholar 

  13. Rossi M, Muehlberger M . Neonatal Exposure to DEHP (di-2-ethylhexyl phthalate) and Opportunities for Prevention in Europe: Health Care Without Harm; Falls Church, VA, 2000.

  14. Stuer-Lauridsen F, Mikkelsen S, Havelund S, Birkved M, Hansen L . Environmental and Health Assessment of Alternatives to Phthalates and to Flexible PVC. Danish Environmental Protection Agency, COWI Consulting Engineers and Planners AS; Copenhagen, Denmark, 2001.

    Google Scholar 

  15. Tickner J, Rossi M, Haiama N, Lappe M, Hunt P . The Use of di-2-ethylhexyl phthalate in PVC medical devices: exposure, toxicity, and alternatives. University of Massachusetts, Lowell Center for Sustainable Production; Lowell, MA, 1999.

    Google Scholar 

  16. Turner VS, Mitchell SG, Kang SK, Hawker RJ . A comparative study of platelets stored in polyvinyl chloride containers plasticised with butyryl trihexyl citrate or triethylhexyl trimellitate. Vox Sang 1995; 69 (3): 195–200.

    Article  CAS  Google Scholar 

  17. Calafat AM, Needham LL, Silva MJ, Lambert G . Exposure to Di(2-ethylhexyl) phthalate among premature neonates in a neonatal intensive care unit. Pediatrics 2004; 113 (5): e429–e434.

    Article  Google Scholar 

  18. Green R, Hauser R, Calafat A, Weuve J, Schettler T, Ringer S et al. Use of Di (2-ethylhexyl) Phthalate-Containing Medical Products and Urinary Levels of Mono (2-ethyhexyl) Phthalate in Neonatal Intensive Care Unit Infants. Environ Health Perspect 2005; 113 (9): 1222–1225.

    Article  CAS  Google Scholar 

  19. NTP (National Toxicology Program). Center for the Evaluation of Risks to Human Reproduction (CERHR). NTP CERHR Expert Panel Report on Di(2-ethylhexyl) Phthalate. Alexandria, VA: NTP CERHR, 2000.

  20. Kohn MC, Parham F, Masten SA, Portier CJ, Shelby MD, Brock JW et al. Human exposure estimates for phthalates. Environ Health Perspect 2000; 108 (10): A440–A442.

    Article  CAS  Google Scholar 

  21. Arcadi FA, Costa C, Imperatore C, Marchese A, Rapisarda A, Salemi M et al. Oral toxicity of bis(2-ethylhexyl) phthalate during pregnancy and suckling in the Long-Evans rat. Food Chem Toxicol 1998; 36 (11): 963–970.

    Article  CAS  Google Scholar 

  22. Borch J, Ladefoged O, Hass U, Vinggaard AM . Steroidogenesis in fetal male rats is reduced by DEHP and DINP, but endocrine effects of DEHP are not modulated by DEHA in fetal, prepubertal and adult male rats. Reprod Toxicol 2004; 18 (1): 53–61.

    Article  CAS  Google Scholar 

  23. Davis BJ, Maronpot RR, Heindel JJ . Di-(2-ethylhexyl) phthalate suppresses estradiol and ovulation in cycling rats. Toxicol Appl Pharmacol 1994; 128 (2): 216–223.

    Article  CAS  Google Scholar 

  24. Fabjan E, Hulzebos E, Mennes W, Piersma AH . A category approach for reproductive effects of phthalates. Crit Rev Toxicol 2006; 36 (9): 695–726.

    Article  CAS  Google Scholar 

  25. Foster PM, Thomas LV, Cook MW, Gangolli SD . Study of the testicular effects and changes in zinc excretion produced by some n-alkyl phthalates in the rat. Toxicol Appl Pharmacol 1980; 54 (3): 392–398.

    Article  CAS  Google Scholar 

  26. Ge RS, Chen GR, Tanrikut C, Hardy MP . Phthalate ester toxicity in Leydig cells: developmental timing and dosage considerations. Reprod Toxicol 2007; 23 (3): 366–373.

    Article  CAS  Google Scholar 

  27. Jarfelt K, Dalgaard M, Hass U, Borch J, Jacobsen H, Ladefoged O . Antiandrogenic effects in male rats perinatally exposed to a mixture of di(2-ethylhexyl) phthalate and di(2-ethylhexyl) adipate. Reprod Toxicol 2005; 19 (4): 505–515.

    Article  CAS  Google Scholar 

  28. Kavlock R, Barr D, Boekelheide K, Breslin W, Breysse P, Chapin R et al. NTP-CERHR monograph on the potential human reproductive and developmental effects of di(2-ethylhexyl) phthalate (DEHP). Services USDoHaH, NIH 2006.

  29. Lamb JC, Chapin RE, Teague J, Lawton AD, Reel JR . Reproductive effects of four phthalic acid esters in the mouse. Toxicol Appl Pharmacol 1987; 88 (2): 255–269.

    Article  CAS  Google Scholar 

  30. Lee BM, Koo HJ . Hershberger assay for antiandrogenic effects of phthalates. J Toxicol Environ Health A 2007; 70 (15–16): 1365–1370.

    Article  CAS  Google Scholar 

  31. Lovekamp-Swan T, Davis BJ . Mechanisms of phthalate ester toxicity in the female reproductive system. Environ Health Perspect 2003; 111 (2): 139–145.

    Article  CAS  Google Scholar 

  32. Marsee K, Woodruff TJ, Axelrad DA, Calafat AM, Swan SH . Estimated daily phthalate exposures in a population of mothers of male infants exhibiting reduced anogenital distance. Environ Health Perspect 2006; 114 (6): 805–809.

    Article  CAS  Google Scholar 

  33. Nabae K, Doi Y, Takahashi S, Ichihara T, Toda C, Ueda K et al. Toxicity of di(2-ethylhexyl)phthalate (DEHP) and di(2-ethylhexyl)adipate (DEHA) under conditions of renal dysfunction induced with folic acid in rats: enhancement of male reproductive toxicity of DEHP is associated with an increase of the mono-derivative. Reprod Toxicol 2006; 22 (3): 411–417.

    Article  CAS  Google Scholar 

  34. Sjoberg P, Lindquist NG, Montin G, Ploen L . Effects of repeated intravenous infusions of the plasticizer di-(2-ethylhexyl) phthalate in young male rats. Arch Toxicol 1985; 58 (2): 78–83.

    Article  CAS  Google Scholar 

  35. Swan S, Main K, Liu F . Decrease in Anogenital Distance among Male Infants with Prenatal Phthalate Exposure. Environ Health Perspect 2005; 113 (8): 1056–1061.

    Article  CAS  Google Scholar 

  36. Swan SH . Environmental phthalate exposure in relation to reproductive outcomes and other health endpoints in humans. Environ Res 2008; 108 (2): 177–184.

    Article  CAS  Google Scholar 

  37. von Rettberg H, Hannman T, Subotic U, Brade J, Schaible T, Waag KL et al. Use of di(2-ethylhexyl)phthalate-containing infusion systems increases the risk for cholestasis. Pediatrics 2009; 124 (2): 710–716.

    Article  Google Scholar 

  38. Karle VA, Short BL, Martin GR, Bulas DI, Getson PR, Luban NL et al. Extracorporeal membrane oxygenation exposes infants to the plasticizer, di(2-ethylhexyl)phthalate. Crit Care Med 1997; 25 (4): 696–703.

    Article  CAS  Google Scholar 

  39. Scheirs J . End-of-Life Environmental Issues with PVC in Australia. Final Report: ExcelPlas Polymer Technology; June 17 2003.

  40. USFDA. Safety Assessment of Di (2-ethyhexyl) phthalate (DEHP) Released from PVC Medical Devices. In: USFDA CfDaRH, (eds). United States Food and Drug Administration, Rockville, MD, 2001.

  41. Hansen OG . Phthalate labelling of medical devices. Med Device Technol 2007; 18 (6): 10–12.

    PubMed  Google Scholar 

  42. Health Canada. Medical Devices Bureau, Therapeutic Products Directorate Health Products and Foods Branch. Health Canada Expert Advisor Panel on DEHP in Medical Devices: Final Report 11 January 2002. Health Canada: Ottawa.

  43. HCWH. Health Care Without Harm. Summary of the FDA safety assessment of DEHP released from PVC medical Devices: What is Says, what′s next?.HWCW Going Green: A Resource Kit for Pollution Prevention in Health Care 2002, Publ. No. 3–8.

  44. HCWH. Health Care Without Harm: Alternatives to Polyvinyl Chloride (PVC) Medical Devices for the Neonatal Intensive Care Unit (NICU). In: HWCW (ed). Going Green: A Resource Kit for Pollution Prevention in Health Care 2008, Publ. No. 3–21.

  45. Balbus J . Ushering in the new toxicology: toxicogenomics and the public interest. Environ Health Perspect 2005; 113 (7): 818–822.

    Article  CAS  Google Scholar 

  46. SCENIHR. Preliminary report on the safety of medical devices containing DEHP-plasticized PVC or other plasticizers on neonates and other groups possibly at risk. Scientific Committee on Emerging and Newly-Identified Health Risks, Health and Consumer Protection Directorate-General, European Commission 2007.

  47. TURI. Five chemicals alternatives assessment study. Toxics Use Reduction Institute, University of Massachusetts, Lowell, MA, 2006.

  48. Crespo J, Balart R, Sanchez L, Lopez J . Substitution of Di(2-ethylhexyl) Phthalate by Di(isononyl) Cyclohexane-1,2-Dicarboxylate as a Plasticizer for Industrial Vinyl Plastisol Formulations. J Appl Polym Sci 2007; 104: 1215–1220.

    Article  CAS  Google Scholar 

  49. BASF. Hexamoll DINCH for Medical Devices. 2008; (accessed 15 January 2009) http://www.weichmacher.basf.com/icms/basf_1/de/dt.jsp?setCursor=1_216771_216773.

  50. IARC. International Agency for Research on Cancer. Di(2-ethylhexyl)adipate. IARC Monographs on the evaluation of the carcinogenic risks to humans: some industrial chemicals. In: Cancer. IAfRo, (ed). World Health Organization: Lyon, France, 2000, pp 149–175.

  51. ICI. Di-(2-ethylhexyl)adipate: teratogenicity study in the rat. ICI Central Toxicology Loboratory. Imperial Chemical Industries (ICI). Report No. CTL/P/2119. Unpublished study cited in Review of Exposure and Toxicity Data for Phthalate Substitutes (2010). 1988.

  52. ICI. Di-(2-ethylhexyl)adipate (DEHA) fertility study in the rats. ICI Central Toxicology Laboratory. Imperial Chemical Industries (ICI). Report No. CTL/P/2229. Unpublished study cited in Review of Exposure and Toxicity Data for Phthalate Substitutes (2010). 1988.

  53. Scientific committee on Toxicity, Ecotoxicity and the Environment (CSTEE). Opinion on the toxicological characteristics and risks of certain citrates and adipates used as a substitute for phthalates as plasticisers in certain soft PVC products. European Commission, Directorate- General Health and Consumer Protection, Directorate B—Scientific Opinions on Health Matters, Unit B2—Management of Scientific Committees I, Scientific Committee on Toxicity, Ecotoxicity and the Environment: Brussels, Septemer 1999.

  54. The British Industrial Biological Research Association (BIBRA). Toxicity Profile—Acetyl Tributyl Citrate. TNO BIBRA International Ltd, 1989. Cited in Stuer-Lauridsen (2001).

  55. High Production Volume (HPV) Chemical Challenge Program Test Plan. Test plan for the Trimellitate category under the Environmental Protection Agency's High Production Volume (HPV) Chemical Challenge Program. Exxon Mobil Biomedical Science, December 2001. Available at http://www.epa.gov/hpv/pubs/summaries/trime/c13468tc.htm.

  56. HCWH (Health Care Without Harm). Reducing polyvinyl chloride (PVC) use in hospitals. In: HCWH (ed.). Going Green: A Resource Kit for Pollution Prevention in Health Care, pub 3-04, 15 October, 2002. Available at http://www.noharm.org.

  57. HCWH (Health Care Without Harm). The weight of evidence on DEHP: overview of legal actions to restrict the use of phthalates particularly in relation to medical care. In: HCWH (ed.). March 2005. Available at http://www.noharm.org.

  58. European Parliament 2001. Environmental Aspects of PVC, A5-0002/200. European Parliament resolution on the Commission Green Paper (COM(2000) 469-C5-0633.2000–2000/2297 (COS)). Available at http://eur-lex.europa.eu/smartapi/cgi/sga_doc?smartapi!celexplus!prod!DocNumber&lg=en&type_doc=COMfinal&an_doc=2000&nu_doc=469.

  59. Welle F, Wolz G, Franz R . Migration of plasticizers from PVC tubes into enteral feeding solutions. Pharma International 2005; 3: 17–21.

    Google Scholar 

  60. Review of Exposure and Toxicity Data for Phthalate Substitutes. Prepared for U.S. Consumer Product Safety Commission by Versar, Inc. and Syracuse Research Corporation (SRC); Springfield, VA, 2010 (accessed 5 November 2010): www.cpsc.gov/about/cpsia/phthalsub.pdf.

  61. Hodge H, Maynard E, Downs W, Ashton J, Salerno L . Tests on mice for evaluating carcinogenicity. Toxicol Appl Pharmacol 1966; 9: 583–596.

    Article  CAS  Google Scholar 

  62. Kluwe WM . Carcinogenic potential of phthalic acid esters and related compounds: structure-activity relationships. Environ Health Perspect 1986; 65: 271–278.

    CAS  PubMed  PubMed Central  Google Scholar 

  63. Kluwe WM, Huff JE, Matthews HB, Irwin R, Haseman JK . Comparative chronic toxicities and carcinogenic potentials of 2-ethylhexyl-containing compounds in rats and mice. Carcinogenesis 1985; 6 (11): 1577–1583.

    Article  CAS  Google Scholar 

  64. NTP. National Toxicology Program. Carcinogenesis bioassay of di(2-ethylhexyl)adipate (CAS no. 103-23-1) in F344 rats and B6C3F1 mice. NTP-80-29 NIH Publ 1982; 81: 1768.

    Google Scholar 

  65. Borch J, Dalgaard M, Ladefoged O . Early testicular effects in rats perinatally exposed to DEHP in combination with DEHA—apoptosis assessment and immunohistochemical studies. Reprod Toxicol 2005; 19 (4): 517–525.

    Article  CAS  Google Scholar 

  66. Dalgaard M, Hass U, Vinggaard AM, Jarfelt K, Lam HR, Sorensen IK et al. Di(2-ethylhexyl) adipate (DEHA) induced developmental toxicity but not antiandrogenic effects in pre- and postnatally exposed Wistar rats. Reprod Toxicol 2003; 17 (2): 163–170.

    Article  CAS  Google Scholar 

  67. Kang JS, Morimura K, Toda C, Wanibuchi H, Wei M, Kojima N et al. Testicular toxicity of DEHP, but not DEHA, is elevated under conditions of thioacetamide-induced liver damage. Reprod Toxicol 2006; 21 (3): 253–259.

    Article  CAS  Google Scholar 

  68. HSDB. Acetyl Tributyl Citrate, CASRN: 77-90-7. Hazardous Substances Data Bank (HSDB);TOXNET January 13, 2005 (accessed 18 January 2009): http://toxnet.nlm.nih.gov/cgi-bin/sis/search/f?./temp/∼8kpUC9:1.

  69. Chawla AS, Hinberg I . Leaching of plasticizers from and surface characterization of PVC blood platelet bags. Biomater Artif Cells Immobilization Biotechnol 1991; 19 (4): 761–783.

    Article  CAS  Google Scholar 

  70. Christensson A, Ljunggren L, Nilsson-Thorell C, Arge B, Diehl U, Hagstam KE et al. In vivo comparative evaluation of hemodialysis tubing plasticized with DEHP and TEHTM. Int J Artif Organs 1991; 14 (7): 407–410.

    Article  CAS  Google Scholar 

  71. Flaminio LM, De Angelis L, Ferazza M, Marinovich M, Galli G, Galli CL . Leachability of a new plasticizer tri-(2-ethylhexyl)-trimellitate from haemodialysis tubing. Int J Artif Organs 1988; 11 (6): 435–439.

    CAS  PubMed  Google Scholar 

  72. Kambia K, Dine T, Azar R, Gressier B, Luyckx M, Brunet C . Comparative study of the leachability of di(2-ethylhexyl) phthalate and tri(2-ethylhexyl) trimellitate from haemodialysis tubing. Int J Pharm 2001; 229 (1–2): 139–146.

    Article  CAS  Google Scholar 

  73. Quinn MA, Clyne JH, Wolf MM, Cruickshank D, Cooper IA, McGrath KM et al. Storage of platelet concentrates—an in vitro study of four types of plastic packs. Pathology 1986; 18 (3): 331–335.

    Article  CAS  Google Scholar 

  74. IUCLUD. Public data on high volume chemicals. In: European Commission Joint Research Center (ed). European Chemical Bureau; EUR 19559 EN 2000.

  75. David RM, Lockhart LK, Ruble KM . Lack of sensitization for trimellitate, phthalate, terephthalate and isobutyrate plasticizers in a human repeated insult patch test. Food Chem Toxicol 2003; 41 (4): 589–593.

    Article  CAS  Google Scholar 

  76. Subotic U, Hannmann T, Kiss M, Brade J, Breitkopf K, Loff S . Extraction of the plasticizers diethylhexylphthalate and polyadipate from polyvinylchloride nasogastric tubes through gastric juice and feeding solution. J Pediatr Gastroenterol Nutr 2007; 44 (1): 71–76.

    Article  CAS  Google Scholar 

  77. Lichtman B . Flexible PVC Faces Stiff Competition. Medical Device Link 2000.

  78. Rahman M, Brazel C . The Plasticizer market: an assessment of traditional plasticizers and research trends to meet new challenges. Prog Polym Sci 2004; 29: 1223–1248.

    Article  CAS  Google Scholar 

  79. Koop CE, Juberg DR, Benedek EP, Brecher RW, Brent RL, Cole P et al. A scientific evaluation of health effects of two plasticizers used in medical devices and toys: A report from the American Council on Science and Health. MedGenMed 1999; E14; p 11.

  80. Loff PD, Subotic U, Oulmi-Kagermann J, Kranzlin B, Reinecke MF, Staude C . Diethylhexylphthalate extracted by typical newborn lipid emulsions from polyvinylchloride infusion systems causes significant changes in histology of rabbit liver. JPEN J Parenter Enteral Nutr 2007; 31 (3): 188–193.

    Article  CAS  Google Scholar 

  81. NTP (National Toxicology Program). Chronic toxicity summary. Propylene (CAS 115-07-1). National Toxicity Program, NIH, 2007.

  82. Quest JA, Tomaszewski JE, Haseman JK, Boorman GA, Douglas JF, Clarke WJ . Two-year inhalation toxicity study of propylene in F344/N rats and B6C3F1 mice. Toxicol Appl Pharmacol 1984; 76 (2): 288–295.

    Article  CAS  Google Scholar 

  83. Sartori S, Trevisani L, Nielsen I, Tassinari D, Ceccotti P, Abbasciano V . Longevity of silicone and polyurethane catheters in long-term enteral feeding via percutaneous endoscopic gastrostomy. Aliment Pharmacol Ther 2003; 17 (6): 853–856.

    Article  CAS  Google Scholar 

  84. Blacka J, Donoghue J, Sutherland M, Martincich I, Mitten-Lewis S, Morris P et al. Dwell time and functional failure in percutaneous endoscopic gastrostomy tubes: a prospective randomized-controlled comparison between silicon polymer and polyurethane percutaneous endoscopic gastrostomy tubes. Aliment Pharmacol Ther 2004; 20 (8): 875–882.

    Article  CAS  Google Scholar 

  85. Bjorling G, Axelsson S, Johansson UB, Lysdahl M, Markstrom A, Schedin U et al. Clinical use and material wear of polymeric tracheostomy tubes. Laryngoscope 2007; 117 (9): 1552–1559.

    Article  Google Scholar 

  86. Mair AA, Mair EA . Can plastic tracheotomy tubes harm baby boys? Otolaryngol Head Neck Surg 2009; 140 (1): 13–14.

    Article  Google Scholar 

  87. NTP. National Toxicology Program. CAS Registry Number: 108-05-4 (Vinyl acetate). ChemIDPlus: National Toxicity Program, 2007.

  88. Sarkar NN . The combined contraceptive vaginal device (NuvaRing): a comprehensive review. Eur J Contracept Reprod Health Care 2005; 10 (2): 73–78.

    Article  CAS  Google Scholar 

  89. Busch H . Silicone toxicology. Semin Arthritis Rheum 1994; 24 (1 Suppl 1): 11–17.

    Article  CAS  Google Scholar 

  90. NTP. The Immunotoxicity of Silicone. (CAS 9016-00-6), National Toxicity Program. National Institutes of Health (NIH); Research Triangle Park, NC, 2007.

  91. Trudel J, Gauderer MW, Drews MJ, LaBerge M . Lipid uptake by silicone enteral access feeding devices. J Pediatr Surg 1998; 33 (6): 880–884.

    Article  CAS  Google Scholar 

  92. Tickner JA, Schettler T, Guidotti T, McCally M, Rossi M . Health risks posed by use of Di-2-ethylhexyl phthalate (DEHP) in PVC medical devices: a critical review. Am J Ind Med 2001; 39 (1): 100–111.

    Article  CAS  Google Scholar 

  93. Jaeger RJ, Weiss AL, Brown K . Infusion of di-2-ethylhexylphthalate for neonates: a review of potential health risk. J Infus Nurs 2005; 28 (1): 54–60.

    Article  Google Scholar 

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Acknowledgements

This work was supported by NIH R01 ES013543, 5 P30 ES009089 and T32 ES007322. Research for this manuscript was carried out in part by MPH students in the Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University. We would like to gratefully acknowledge the contributions of Sarah Autry, Alexis Harman, Kristen Coates, Elizabeth DelGiacco, Anthony Oliver, Jordana Rothchild and Sheila Viswanathan.

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  1. Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA

    E D S Van Vliet, E M Reitano, J S Chhabra, G P Bergen & R M Whyatt

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Van Vliet, E., Reitano, E., Chhabra, J. et al. A review of alternatives to di (2-ethylhexyl) phthalate-containing medical devices in the neonatal intensive care unit. J Perinatol 31, 551–560 (2011). https://doi.org/10.1038/jp.2010.208

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