Newborns in hospital intensive care units are vulnerable in so many ways.
Their paper-thin skin can be torn by medical tape. Their lungs may not be developed enough to supply their tiny bodies with oxygen. Their immature immune systems leave them susceptible to a wide world of germs.
Now, a growing number of hospitals are trying to protect babies like these from a newly recognized threat — the medical equipment that provides them with lifesaving blood, medicine or nutrition.
The plastic used in intravenous tubing, blood bags and other products — DEHP, or di(2-ethylhexyl) phthalate — can leach a hormone-like chemical linked to reproductive problems, says Richard Grady, interim chief of pediatric urology at Seattle's Children's Hospital & Regional Medical Center. While doctors agree that the benefits of specialized care for newborns outweigh the potential risks from plastic devices, leading medical organizations now say that hospitals should find safer substitutes whenever possible.
Grady notes that even minute amounts of hormones could cause problems for infants whose organs are still developing, especially newborn boys who spends weeks in neonatal intensive care units, or NICUs.
Manufacturers say their products are safe and note that there are only a few human studies of DEHP. Many doctors and nurses say they're concerned, however, about animal studies that suggest the chemical can suppress testosterone, impair fertility and alter the development of reproductive organs.
The Seattle hospital and more than 100 others across the USA have pledged to begin phasing out DEHP. Influential groups such as the American Medical Association and American Nurses Association in recent months also have urged hospitals to find safer substitutes.
Officials at hospitals such as Lucile Packard Children's Hospital at Stanford and John Muir Medical Center in Walnut Creek, Calif., say they've saved money since making the switch. While some DEHP-free products are cheaper, others are lighter, which saves money on waste disposal.
Jolene Farris of San Jose, Calif. had never heard of DEHP before giving birth last week. But she says she's glad that he's in a hospital using safer plastics to treat her son, Jameson, who was born about 8 weeks early. "They're already so small, why take the chance?" Farris asks. "It absolutely makes me feel safer."
But Grady says avoiding DEHP — which he calls "the everywhere chemical" — is no easy task. Beyond IV tubes, DEHP — which adds flexibility to polyvinyl chloride plastic, or PVC — is also found in a variety of consumer products, including flooring, wallpaper, auto upholstery, food packaging and toys.
Plastics often have no labels listing their ingredients, says Kathy Gerwig, vice president of workplace safety at Kaiser Permanente, the country's largest non-profit health system. "There's no way to know just by looking," says Gerwig, who says Kaiser now has phased out all DEHP in its neonatal intensive care units, except where substitutes are unavailable. "It was a hunt and guess process."
Manufacturers often refused to reveal the ingredients in their products, noting that ingredients are trade secrets, Gerwig says. "Even given our enormous size and buying power, we have had relatively little power getting this information," she says. "It really puts the burden on the user."