Hazards of laundry products used in the newborn nursery

Published reports and unpublished communications to the Committee on Drugs of the American Academy of Pediatrics indicate that substances potentially hazardous to the premature and full-term newborn infant continue to be used in the laundering of clothing, diapers, and bedding for hospital nurseries. In 1962 the Subcommittee on Accidental Poisoning called attention to occurrences of methemoglobinemia in premature and full-term newborn infants whose diapers were autoclaved after a final laundry rinse with the bacteriostatic agent, 3-4-4' trichlorocarbanilide (TCC).1 Subsequent reports in the pediatric literature confirmed and added to these "epidemics" of neonatal methemoglobinemia2-4 and suggested that aniline–a wellknown cause of methemoglobinemia5–resulting from the break-down of TCC during autoclaving, was absorbed from diapers and other nursery clothing through the skin of the infants. Although direct proof of the etiologic role of TCC is lacking, the association is of sufficient concern that the forthcoming Academy manual, Standards and Recommendations for Hospital Care of Newborn Infants, Second Edition, makes reference to the hazards of using TCC. Although a limited and informal survey of hospital nurseries in the United States and Canada indicates that most hospital laundry procedures have abandoned TCC in treating clothing and bed linens of newborn infants, sporadic instances of neonatal methemoglobinemia associated with exposure to this substance still come to the attention of local, state, and national health agencies, manufacturers, and the Committee on Drugs. In 1967, deaths and severe illness occurred in epidemic form in the newborn nursery of a small Midwestern maternity hospital.6 Investigation revealed that the sodium salt of pentachlorophenol (PCP)— which was present in the antimicrobial neutralizer product used in the final rinse of the laundry process for diapers, infant undershirts, and crib linens for the nursery–intoxicated babies by percutaneous absorption.7