Neonatal Intensive Care Units (NICUs) provide critically important care for sick newborns.  Those of us who work in NICUs care deeply about our patients and are committed to creating the safest possible environment for the delivery of care.  Health Care Without Harm’s NICU pledge provides one way to protect neonates from unnecessary harm.

Many of the products that we use in the NICU are made from polyvinyl chloride (PVC or "vinyl") plastic.  To make PVC flexible, manufacturers add chemicals like di(2 –ethylhexyl) phthalate (DEHP).  These softening agents, or plasticizers, are commonly added to PVC medical devices.  The problem with DEHP is that it doesn’t stay in the plastic.  Not chemically bound to PVC, it leaches out of medical devices, leading to human exposure to DEHP,  including to neonates in the NICU. DEHP, as well as other phthalates, also leaches out of PVC building materials/furnishings, contaminating the general environment.  These sources can also contribute to  aggregate DEHP exposures. 

Researchers studying the effects of DEHP on animals have uncovered disturbing evidence relevant to humans.  DEHP adversely affects the developing male reproductive system, with neonates being especially vulnerable.  An expert panel of the National Toxicology Program’s Center for Evaluation of Risks to Human Reproduction concluded that DEHP raised "serious concerns" for neonates. The Food and Drug Administration concurred with the NTP findings and issued a  public health notification recommending the use of alternatives to DEHP where exposures might be excessive, including in the NICU.

Hospitals are creating safer environments for NICU patients by selecting from an array of PVC- and DEHP-free products  that meet their performance needs.  It is incumbent on medical professionals to "do no harm" by eliminating the use of DEHP wherever possible.

Health Care Without Harm introduced the NICU Pledge to recognize the many NICUs who already have committed to reducing their use of PVC/DEHP and to help additional hospitals reduce their use of DEHP.  The Pledge outlines steps for a commitment to reduce DEHP-containing medical devices, flooring and other materials in the NICU.  By reviewing the NICU Pledge and endorsing it on behalf of your hospital, you will be identified as a leader in the NICU community on environmental stewardship, one of health care's essential responsibilities.

We thank you in advance for downloading the NICU Pledge and discussing it at your workplace and letting us know you will help phase out DEHP in your hospital.

  For more information about DEHP and PVC, go to http://www.noharm.org/us/pvcDehp/issue.

  Click here to let us know how you will move forward on one or more steps in the Pledge.

Key Resources

 Download the NICU Pledge (pdf)

Many hospitals are reducing PVC & DEHP use - Learn More

Why Health Care is Moving Away from PVC (pdf)

PVC & DEHP - The Issue

Replacing DEHP: Hospital Case Studies

The Weight of the Evidence on DEHP (pdf)

Alternatives to PVC and DEHP Medical Devices (pdf)

Alternatives to PVC Medical Devices for the NICU (pdf)

Alternatives to PVC Building Materials for the NICU (pdf)