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

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.