Phthalate exposure from medical tubes linked to attention-deficit disorder in critically ill children

BOSTON — Children exposed to phthalates from plastic tubes or catheters for extended periods of time during a critical illness are more likely to develop attention-deficit disorder, according to study findings presented here.

“Phthalates have been banned from children’s toys because of their potential toxic and hormone-disrupting effects, but they are still used to soften medical devices,” Sören Verstraete, MD, a PhD student at Katholieke University Leuven in Belgium, said in a press release. “We found a clear match between previously hospitalized children’s long-term neurocognitive test results and their individual exposure to the phthalate [di(2-ethylhexyl)phthalate] during intensive care.”

Sören Verstraete

Verstraete and colleagues analyzed circulating plasma concentrations of di(2-ethylhexyl)phthalate (DEHP) metabolites from 100 healthy children and 449 children treated in a pediatric ICU with one to 12 medical tubes who underwent neurocognitive testing 4 years later. In a development patient cohort (n = 228), researchers identified stable thresholds of exposure to circulating DEHP metabolites and found an association between DEHP levels that exceeded the thresholds and worse neurocognitive outcome. A second patient cohort (n = 221) validated the observed independent associations.

Researchers found that plasma concentrations of DEHP metabolites were “virtually undetectable” in healthy children (0.029 µmol/L; 95% CI, 0.027-0.031) vs. 4.41 µmol/L in critically ill children upon pediatric ICU admission (95% CI, 3.76-5.06). Plasma DEHP metabolite concentrations decreased rapidly but remained 18 times elevated until pediatric ICU discharge (P < .001). Exposure to circulating DEHP metabolites above the threshold was independently associated with attention deficit after adjusting for baseline risk factors, duration of pediatric ICU stay, pediatric ICU complications and treatments (P .008 for all), as well as impaired motor coordination (P .02 for all). The association with attention deficit was confirmed in the validation cohort (P .01).

Verstraete said phthalate exposure explained half of the attention deficit in former pediatric ICU patients, and other factors may account for the other half.

“We should also test the existing alternative plasticizers in a similar study,” Verstraete told Endocrine Today. “We don’t want to just replace potential toxic substances with others.” – by Regina Schaffer

Reference :

Verstraete S, et al. OR04-6. Presented at: The Endocrine Society Annual Meeting; April 1-4, 2016; Boston.

Disclosure: The researchers report no relevant financial disclosures.