High concentrations of urinary ethanol metabolites in neonatal intensive care unit infants

Pediatr Res. 2020 Dec;88(6):865-870. doi: 10.1038/s41390-020-1020-5. Epub 2020 Jun 20.


Background: Infants in the neonatal intensive care unit may be exposed to ethanol via medications that contain ethanol as an excipient and through inhalation of ethanol vapor from hand sanitizers. We hypothesized that both pathways of exposure would result in elevated urinary biomarkers of ethanol.

Methods: Urine samples were collected from infants in incubators and in open cribs. Two ethanol metabolites, ethyl sulfate (EtS) and ethyl glucuronide (EtG), were quantified in infants' urine.

Results: A subset of infants both in incubators and open cribs had ethanol biomarkers greater than the cutoff concentration that identifies adult alcohol consumption. These concentrations were associated with the infant having received an ethanol-containing medication on the day of urine collection. When infants who received an ethanol-containing medication were excluded from analysis, there was no difference in ethanol biomarker concentrations between the incubator and crib groups.

Conclusions: Some infants who received ethanol-containing medications had concentrations of ethanol biomarkers that are indicative of adult alcohol consumption, suggesting potential exposure via ethanol excipients.

Impact: Infants and newborns in the neonatal intensive care unit are exposed to concerning amounts of ethanol. No one has shown exposure to ethanol in these infants before this study. The impact is that better understanding of the excipients in medications given to patients in the NICU is needed. When physicians order medications in the NICU, the amount of excipient needs to be indicated.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Biomarkers
  • Chromatography, Liquid
  • Ethanol / adverse effects
  • Ethanol / urine*
  • Female
  • Glucuronates / urine
  • Hand Sanitizers / adverse effects
  • Humans
  • Incubators
  • Infant
  • Infant, Newborn
  • Infant, Premature / urine
  • Intensive Care Units, Neonatal*
  • Intensive Care, Neonatal / methods*
  • Male
  • Mass Spectrometry
  • Sulfuric Acid Esters / urine


  • Biomarkers
  • Glucuronates
  • Hand Sanitizers
  • Sulfuric Acid Esters
  • ethyl glucuronide
  • Ethanol
  • diethyl sulfate