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The chemical component has been detected in the soil, food, and water and therefore has been recognized as a widespread environment pollutant. Phthalates have been found in many environments including in human bodies, animals, and in baby milk formulae. The action of DEHP is dependent on dosage, time of exposure, and age and thus DEHP exposure risk is presumably higher in infants, especially at the early stage of development and pregnant women. The initial metabolism of DEHP is similar among mammals and therefore animal studies have been used as basis for understanding the adverse effects of human exposure.
DEHP can leak from medical devices containing IV or blood bags into fluids such as plasma, blood and enterable nutrition solutions. Through medical interventions, the need long-term IV interaction, for instance in hem dialysis, exposure to DEHP is considerably enhanced. Sick newborns and babies are faced with the greatest risk of exposure from medical involvements and are also the most susceptible to the harmful effects of DEHP due to this stage of human development. Animal experimentations data on DEHP exposure show that adverse effects include, reduced sperm production in males, reduced fertility, and ovaries dysfunction in females. Among the areas where high DEHP occur are during blood transfusion, heart surgery and extracorporeal membrane oxygenation (EMCO) (Giuseppe, 103).
Effects of DEHP to infants
Di (2-ethylhexyl) phthalate (DEHP) is used to manufacture polyvinyl chloride (PVC) flexible and soft plastic tubing. Human exposure to DEHP occurs throughout life and the most worrying is that which involves exposure to fetuses, babies, and preterm infants since the developing human being reproductive system may be affected when metabolic paths of detoxification are not fully developed. Animal tests have shown that DEPH damages the reproductive systems of both male and female animals. Studies have shown that DEHP is predominantly risky to developing fetuses and adverse results are seen in the reproductive system which includes changes in sperm production in males and changes in testes particularly the Sertoli cells which results to reduced fertility. In females, there is ovarian dysfunction and decreased hormone production. DEHP exposure has also been observed to cause respiratory distress and affect kidney and liver function.
Concentrations of DEHP in blood and blood products are of major concern for neonates who receive regular blood transfusions. Blood products mostly used are plasma and red blood cells are stored in DEHP plasticized bags and are introduced to the patients through DEHP plasticized intravenous tubes. Inside the human body, DEHP is metabolized to various substances that are excreted repeatedly. Monoethylhexyl phthalate (MEHP) is thought to be liable for much of DEHP toxicity. Enzymes that breakdown DEHP to MEHP is mainly found in the intestines but is also found in the lungs, pancreas, kidney, liver, and plasma. Since conversion of DEHP to MEHP takes place particularly in the intestinal tract, then exposure to DEHP through ingestion may be more risky than intravenous exposure which bypasses the intestinal tract (Mark and Manfred, 22).
Whereas most of these adverse effects have been noted in experimental animals at high doses, in some cases, these doses are close to what might be experienced by humans undergoing medical treatment. For some effects like testicular toxicity, the developing organism fetus and neonate are more susceptible to toxicity and the damage is more irreversible than in adults. During intensive care in adults, DEHP exposure occurs during three orders of magnitude which are higher than in average adult exposure and levels causing reproductive problems in animals. The outcome of intensive care for infants can lead to multiple exposures to DEHP through multiple paths, intravenously, by inhalation and orally. The overall exposure to DEHP for infants getting various medical treatments in a neonatal intensive care has not been measured. Animal studies have shown that DEHP is mainly harmful to developing fetuses with adverse effects being noted in the reproductive system. Even though some effects are noted after comparatively high levels of exposure, development of male reproductive system is mainly vulnerable to low levels of exposure comparable to those that occur during medical care with DEHP. Exposures in Neonatal Intensive Care Units are probably at levels known to cause adverse health problems in related animal studies (Latini and Ospedale, 154).
Whereas no studies have examined the effects of DEHP foetal development in human's reproductive system, animal tests relevant for predicting the risk in humans imply the effect to be toxic. It therefore creates worry that human exposures are highest in very small and undeveloped off springs when their reproductive organs are developing. After birth, the baby's exposure to DEHP continues at lower levels at home since DEHP is found in the air, baby foods, and breast milk as well. Exposure of humans to DEHP starts at conception since pregnant women are exposed to DEHP in their everyday lives. Flexible PVC items made with DEHP are so omnipresent that the plasticizer is regular pollutant in air, food products and drinking water and all these are possible sources of exposure for pregnant women (Mark Manfred, 17).
Since majority of pregnant women eat more fatty foods than other women, their level of exposure to DEHP is higher. Fatty foods such as cheese, meat, fish and milk normally contain higher DEHP than other foods since DEHP is lipophilic. DEHP off-gasses PVC items since its not bound to PVC and the pace of DEHP leaching depends on storage condition, usage temperature, handling conditions and contact with lipophilic solutions and the percent of DEHP in the product. High lip products such as blood, breast milk, and parentenal formulae readily extract DEHP from PVC bags and tubes.
Pre-term babies such as low weight babies in most cases need a variety of medical treatments that use DEHP plasticized PVC products. DEHP levels in blood and blood products for premature babies receiving regular blood transfusions are of particular concern. Commonly used blood products are packed red blood cells and plasma which are packaged in DEHP plasticized bags and conveyed to patients by use of DEHP plasticized tubes. Respiratory masks, oxygen tubing, suction catheters and humidifier tubing used in respiratory therapy for pre term babies are made of PVC containing DEHP. Exposure of preterm babies with DEHP from plasticized PVC humidifier still continues until today. In preterm babies and infants who cannot be breastfed, there is high DEHP in parentenal nutritions which are passed to the intestinal tract.
Most DEHP exposures in the NICU are preventable since alternative products can be used. Since DEHP off-gassing and PVC leaching from products are uncontrolled sources of contamination, a preventable way are warranted addressing the problem of DEHP exposures. A preventable approach will entail reducing pollution at the source and in the medical field this prevention will call for elimination of use of DEHP containing products. DEHP leaching and off-gassing should be prevented by substituting PVC products with PVC free products(Chen, 34), using PVC free medical products guarantees that they are DEHP-free because the alternative polymers like ethylene vinyl acetate and polypropylene, polyurethane and silicone seldom have added DEHP. In addition substitute products evade the recycling of hazards of PVC including usage of carcinogenic compounds to make PVC and the downstream end product of hydrochloric acid and dioxin after PVC is burned in a medical garbage incinerator. Advocating the use of DEHP-free PVC products in medical field. This can involve use of alternative plasticizers such as trimellitates and citrates.