Non-Treatment of Screened Children With Intermediate Blood Lead Levels

PEDIATRICS ◽  
1975 ◽  
Vol 56 (2) ◽  
pp. 298-302
Author(s):  
Michael C. Klein ◽  
Mary Schlageter
Keyword(s):  
Nurse Practitioner ◽  
Venous Blood ◽  
Lead Level ◽  
Blood Lead ◽  
Small Population ◽  
Personalized Care ◽  
Hot Dry Season ◽  
Lead Levels ◽  
The City

An aggressive screening and follow-up program for children at risk for lead poisoning was conducted by a nurse practitioner in a small family practice unit. Subsequent venous blood lead determinations in untreated cases show the natural fall in lead level over 12 to 18 months. Many of these children would have been chelated by others, yet individualized, specific, personalized care by a nurse practitioner permitted monitoring without treatment even in persistently leaded environments. No chelation therapy was necessary until the third summer, when coincident with a long, hot, dry season, the city's abatement system became nonfunctional. Nontreatment requires close follow-up, a relatively small population, and cooperation from the city.

scholarly journals Against lead poisoning: effectiveness of housing first and counselling in the home

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
R Laporte ◽  
H Barberin de Barberini ◽  
E Jouve ◽  
K Hadji ◽  
S Gentile
Keyword(s):  
Lead Poisoning ◽  
Lead Exposure ◽  
Blood Lead Level ◽  
Lead Level ◽  
Blood Lead ◽  
Housing First ◽  
Blood Lead Levels ◽  
Stable Housing ◽  
Lead Levels

Abstract Background Removing lead sources is the main measure against child lead poisoning. Medical treatment is ineffective for most mild cases and particularly against long-term complications in neurological development. However, the effectiveness of interventions to eliminate sources of lead exposure has not been fully established, mainly because of the diversity of situations. The objective of this study was to determine the influence of several interventions (housing counselling, rehabilitation and relocation) on blood lead levels in two situations (stable unhealthy housing with old flaked lead paints, slums with family recycling practices by incineration). Methodology A historical cohort of lead poisoning in children has been established in Marseille, France. Medical follow-up followed national guidelines. Environmental interventions followed legal procedures, where available. In slums, counselling was adapted to the exposure. A generalized mixed model was developed to study the kinetics of blood lead levels after the interventions. Results 151 children were included; age = 5.4 (SD = 7.8) years; 85 (56%) lived in stable unhealthy housing, others lived in slums. Medical follow-up included 492 blood lead levels. For children living in stable unhealthy housing, blood lead level decrease was significantly associated with every intervention: housing counselling, rehabilitation and relocation (respectively p < 0.005; p < 0.05 and p < 0.005). For children living in slums, blood lead level decrease was only associated with relocation in a stable housing (p < 0.005). Conclusions Several interventions are effective to decrease blood lead levels in unhealthy housing. In slums, access to a stable housing first is a prerequisite for any intervention against child lead poisoning, even when related to family practices. Key messages In stable unhealthy housing, several interventions against lead exposure can be effective to raise a strategy. But, environmental health and access to housing first needs to be addressed for their implementation.

scholarly journals Lead toxicity in a new-born due to in utero exposure

2017 ◽  
Vol 5 (1) ◽  
pp. 245
Author(s):  
Leanna Laor ◽  
Sharlene Sy ◽  
Ruchi Gupta ◽  
Joseph Torres ◽  
Lourdes Cohen
Keyword(s):  
Lead Level ◽  
Lead Toxicity ◽  
Blood Lead ◽  
In Utero ◽  
In Utero Exposure ◽  
Limited Data ◽  
Child Bearing ◽  
Lead Levels

Lead poisoning in a neonate is poorly defined, and limited data exists on appropriate follow-up and treatment of such infants. We are presenting the case of a newborn infant, who had a lead level of 63 mcg/dL. Treatment involved five days of intravenous chelation therapy. At discharge, no clinical sequelae of lead toxicity were found. However, due to the chronic nature of in utero exposure the infant requires close follow-up, in particular neurologic and developmental sequelae. Lead toxicity has many complications. Long-term complications include delays in growth and development. Furthermore, these complications may develop in children with minimal toxicity, let alone those with grossly abnormal values. Due to lack of data, perhaps it is worthwhile to screen those women of child-bearing age, who are of "high risk", for elevated blood lead levels to reduce the risk of in utero exposure.

scholarly journals Paediatric Blood Lead Levels and its Correlation with Anaemia: A Study from Central India

2021 ◽  
Author(s):  
Usha Banga ◽  
Pawan Kumar Sharma ◽  
Jyoti Gupta ◽  
Ashok Banga ◽  
Puneet Agrawal ◽  
...  
Keyword(s):  
Public Awareness ◽  
Venous Blood ◽  
Tertiary Care ◽  
Lead Level ◽  
Blood Lead ◽  
Diagnostic Tools ◽  
Blood Lead Levels ◽  
P Value ◽  
Care Hospital ◽  
Lead Levels

Introduction: Lead is a toxic element used commonly in many products like lead-acid batteries, paints, toys etc. Young children are particularly vulnerable to lead poisoning because of higher absorption capacity in comparison of adults. Safe level of lead exposure has to be established yet. Literature suggests a threshold lead level of 20-40 μg/dL for a decrease in haemoglobin in children. Aim: To assess the correlation between Blood Lead Levels (BLL) and anaemia in children. Materials and Methods: This cross-sectional study was conducted in a Paediatric Tertiary Care Hospital of Gwalior, Madhya Pradesh, India, during the period of May 2019 to September 2020. A 81 children between one to five years of age were included in study. Information was collected regarding general profile of the children and other parameters like socio- economic status (Modified Kuppuswamy scale), history of pica, application of surma, type of toys used, scholastic performance and somatic symptoms. Routine blood investigations were done including Haemoglobin (Hb) and BLL through venous blood sampling. BLL were done at Defense Research and Development Establishment (DRDE) Gwalior. Data entry was done in Microsoft Office Excel 2010 and analysed using Statistical Package for the Social Sciences (SPSS) software version 21.0. Chi-square test with Yates correlation was applied and p-value <0.05 was considered statistically significant. Results: Among 81 study subjects, 53 were males and 28 were females. Total 48 (59.2%) children had Hb <11 gm/dL, 42 (51.8%) children had BLL <5 μg/dL and 32 (39.5%) had BLL between 5-10 μg/dL. There were 9% children (n=7) with BLL more than 10 μg/dL and none beyond 15 μg/dL. In the children it was found to have BLL ≥5 μg/dL, 20 children had Hb levels between 7-11 gm/dL whereas 19 had Hb levels above 11 gm/ dL. No statistically significant association was found between the BLL and childhood anaemia. Conclusion: This study did not show any relationship between BLL and Hb in children of age one to five years. Scarcity of diagnostic tools for detecting BLL and lack of public awareness regarding the probable sources of lead and its complications may result in missing the diagnosis.

scholarly journals Blood lead level and risk of hypertension in the United States National Health and Nutrition Examination Survey 1999–2016

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Man Fung Tsoi ◽  
Chris Wai Hang Lo ◽  
Tommy Tsang Cheung ◽  
Bernard Man Yung Cheung
Keyword(s):  
Blood Pressure ◽  
Lead Exposure ◽  
Blood Lead Level ◽  
Lead Level ◽  
Blood Lead ◽  
The United States ◽  
Study Data ◽  
Blood Lead Levels ◽  
Environmental Lead ◽  
Lead Levels

AbstractLead is a heavy metal without a biological role. High level of lead exposure is known to be associated with hypertension, but the risk at low levels of exposure is uncertain. In this study, data from US NHANES 1999–2016 were analyzed. Adults with blood lead and blood pressure measurements, or self-reported hypertension diagnosis, were included. If not already diagnosed, hypertension was defined according to the AHA/ACC 2017 hypertension guideline. Results were analyzed using R statistics version 3.5.1 with sample weight adjustment. Logistic regression was used to study the association between blood lead level and hypertension. Odds ratio (OR) and 95% confidence interval (95% CI) were estimated. Altogether, 39,477 participants were included. Every doubling in blood lead level was associated with hypertension (OR [95%CI] 1.45 [1.40–1.50]), which remained significant after adjusting for demographics. Using quartile 1 as reference, higher blood lead levels were associated with increased adjusted odds of hypertension (Quartile 4 vs. Quartile 1: 1.22 [1.09–1.36]; Quartile 3 vs. Quartile 1: 1.15 [1.04–1.28]; Quartile 2 vs. Quartile 1: 1.14 [1.05–1.25]). In conclusion, blood lead level is associated with hypertension in the general population with blood lead levels below 5 µg/dL. Our findings suggest that reducing present levels of environmental lead exposure may bring cardiovascular benefits by reducing blood pressure.

Hardness of Domestic Water and Blood Lead Levels

1983 ◽  
Vol 2 (4) ◽  
pp. 645-648 ◽  
Author(s):  
P.C. Elwood ◽  
K.M. Phillips ◽  
N. Lowe ◽  
J.K. Phillips ◽  
C. Toothill
Keyword(s):  
Blood Lead Level ◽  
Lead Level ◽  
Blood Lead ◽  
Hard Water ◽  
Control Area ◽  
Blood Lead Levels ◽  
Domestic Water ◽  
Solvent Water ◽  
Small Rise ◽  
Lead Levels

1 The effect on the blood lead levels of residents in an area in which a soft plumbo-solvent water was hardened is examined. 2 Water lead levels fell after hardening was introduced whereas there was a small rise in water lead levels in a control area monitored over the same time. 3 The blood lead levels of residents fell after hardening and the fall was slightly greater than would have been predicted on the basis of the change in water lead levels. This suggests that lead is less well absorbed from hard water than from soft water. 4 Following hardening there was a significant fall in mean blood lead level of subjects living in houses which had initially had negligible amounts of lead in the water. This suggests that hard water may interfere with the absorption of lead from sources other than water.

Lead Poisoning: Twenty Years After

PEDIATRICS ◽  
1993 ◽  
Vol 92 (3) ◽  
pp. 505-505
Author(s):  
HENRIETTA SACHS ◽  
DONALD I. MOEL
Keyword(s):  
Disease Control ◽  
Lead Poisoning ◽  
Blood Lead Level ◽  
Scientific Evidence ◽  
Lead Level ◽  
Blood Lead ◽  
Neurobehavioral Development ◽  
Long Term Follow Up

To the Editor.— In October 1991, the Centers for Disease Control decreased the blood lead level PbB) from 25 to 10 µg/dL and designated it as abnormal because of "overwhelming and compelling scientific evidence"1 that 10 µg/dL is associated with adverse neurobehavioral development. We have evidence to the contrary, obtained in a long-term follow-up of severely lead-poisoned children whom we treated before 1972 for PbBs between 80 and 470 µg/dL (mean, 150.3 ± 77.1 µg/dL); their mean age was 28 months.

RAPID PROTOPORPHYRIN QUANTITATION FOR DETECTION OF LEAD POISONING

PEDIATRICS ◽  
1972 ◽  
Vol 50 (4) ◽  
pp. 625-631
Author(s):  
Larry P. Kammholz ◽  
L. Gilbert Thatcher ◽  
Frederic M. Blodgett ◽  
Thomas A. Good
Keyword(s):  
Lead Poisoning ◽  
Glacial Acetic Acid ◽  
Blood Lead ◽  
Deficiency Anemia ◽  
Blood Lead Levels ◽  
X Ray ◽  
Fluorescent Method ◽  
Lead Levels ◽  
Fluorescence Test

A rapid fluorescent method for estimation of free erythrocyte protoporphyrin (FEP) is described. Simple ethyl acetate-glacial acetic acid extractions are performed, fluorescence quantitated in a fluorimeter and expressed numerically by comparison with known coproporphyrin standards. Fifty-six children were studied and the extent of lead poisoning was evaluated initially and at different follow-up intervals. A clear relationship was shown between FEP fluorescence and blood lead levels. A correlation was also seen for the intensity of fluorescence and evidence for increased absorption of lead, as estimated by x-ray evidence of ingested lead and deposits in bone. Children with iron deficiency anemia also showed elevations of FEP fluorescence. This FEP fluorescence test allows for a rapid, numerical determination which appears to be useful as a screening test for lead intoxication. It can quickly select patients that may have markedly increased lead absorption and need prompt therapy or select those that at least require further studies for possible lead exposure or the presence of anemia.

High Lead Exposure Associated With Higher Blood Pressure in Haiti: a Warning Sign for Low-Income Countries

Hypertension ◽  
2021 ◽  
Author(s):  
Lily D. Yan ◽  
Vanessa Rouzier ◽  
Jean Lookens Pierre ◽  
Myung Hee Lee ◽  
Paul Muntner ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Diastolic Blood Pressure ◽  
Lead Exposure ◽  
Lead Level ◽  
Blood Lead ◽  
Lower Income ◽  
Environmental Lead ◽  
Lead Levels ◽  
Environmental Lead Exposure ◽  
Lower Income Countries

Cardiovascular disease is the leading cause of death in lower-income countries including Haiti. Environmental lead exposure is associated with high blood pressure and cardiovascular mortality in high-income countries but has not been systematically measured and evaluated as a potential modifiable cardiovascular risk factor in lower-income countries where 6.5 billion people reside. We hypothesized lead exposure is high in urban Haiti and associated with higher blood pressure levels. Blood lead levels were measured in 2504 participants ≥18 years enrolled in a longitudinal population-based cohort study in Port-au-Prince. Lead screening was conducted using LeadCare II (detection limit ≥3.3 µg/dL). Levels below detection were imputed by dividing the level of detection by √2. Associations between lead (quartiles) and systolic blood pressure and diastolic blood pressure were assessed, adjusting for age, sex, obesity, smoking, alcohol, physical activity, income, and antihypertensive medication use. The median age of participants was 40 years and 60.1% were female. The geometric mean blood lead level was 4.73µg/dL, 71.1% had a detectable lead level and 42.3% had a blood lead level ≥5 µg/dL. After multivariable adjustment, lead levels in quartile four (≥6.5 µg/dL) compared with quartile 1 (<3.4 µg/dL) were associated with 2.42 mm Hg (95% CI, 0.36–4.49) higher systolic blood pressure and 1.96 mm Hg (95% CI, 0.56–3.37) higher diastolic blood pressure. In conclusion, widespread environmental lead exposure is evident in urban Haiti, with higher lead levels associated with higher systolic and diastolic blood pressure. Lead is a current and potentially modifiable pollutant in lower-income countries that warrants urgent public health remediation. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03892265.

Blood Lead Screening Practices Among US Pediatricians

PEDIATRICS ◽  
1996 ◽  
Vol 98 (3) ◽  
pp. 372-377
Author(s):  
James R. Campbell ◽  
Stanley J. Schaffer ◽  
Peter G. Szilagyi ◽  
Karen G. O'Connor ◽  
Peter Briss ◽  
...  
Keyword(s):  
Primary Care ◽  
Blood Lead Level ◽  
Lead Level ◽  
Blood Lead ◽  
Blood Lead Levels ◽  
Elevated Blood ◽  
Control And Prevention ◽  
Lead Levels ◽  
Primary Care Pediatricians ◽  
Elevated Blood Lead Levels

Objectives. In 1991, the Centers for Disease Control and Prevention (CDC) decreased the blood lead level of concern to 10 µg/dL (0.48 µmol/L) and recommended universal screening. Because these guidelines continue to provoke controversy, we conducted a study to:1) estimate the proportion of pediatricians who are members of the American Academy of Pediatrics (AAP) who report screening for elevated blood lead levels; 2) describe their clinical practices regarding screening for elevated blood lead levels; 3) compare attitudes of universal screeners, selective screeners, and nonscreeners; and 4) identify characteristics of pediatricians who universally screen. Design. Confidential, cross-sectional survey of a nationally representative random sample of 1610 pediatricians conducted through the AAP Periodic Survey. Subjects. The study included 1035 responders (64% response rate). Analysis was limited to the 734 pediatricians who provide well-child care (ie, primary-care pediatricians). Results. Fifty-three percent of pediatricians reported screening all their patients aged 9 to 36 months, 39% reported screening some, and 8% reported screening none. Among those who screen, 96% use a blood lead assay. The primary risk factors for which selective screeners screen are: history of pica (94%); living in an older home with recent renovations (92%); living in an older home with peeling paint (93%); and having a sibling who had an elevated blood lead level (88%). Among primary-care pediatricians, 73% agree that blood lead levels ≥10 µg/dL should be considered elevated, and 16% disagree. However, 89% of primary-care pediatricians believe that epidemiologic studies should be performed to determine which communities have high proportions of children with elevated blood lead levels, and 34% of primary-care pediatricians believe that the costs of screening exceed the benefits. Conclusions. Three years after the Centers for Disease Control and Prevention issued new guidelines for the management of elevated blood lead levels, a slight majority of primary-care pediatricians in the United States who are members of the AAP report that they universally screen their appropriately aged patients, while most of the remaining pediatricians report screening high-risk patients. Many pediatricians may want additional guidance about circumstances under which selective screening should be considered.

scholarly journals Assessment of a Screening Questionnaire to Identify Exposure to Lead in Pregnant Women

2020 ◽  
Vol 17 (24) ◽  
pp. 9220
Author(s):  
Eléna Coiplet ◽  
Marine Freuchet ◽  
Claire Sunyach ◽  
Julien Mancini ◽  
Jeanne Perrin ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Lead Exposure ◽  
Blood Lead ◽  
Blood Lead Levels ◽  
Cross Sectional ◽  
Lead Levels ◽  
Risk Of Exposure ◽  
Exposure During Pregnancy ◽  
Systematic Identification

Lead readily crosses the placenta and displays adverse effects on birth outcomes and neurodevelopment. Systematic identification of the risk of exposure during pregnancy is essential but rarely performed, probably due to hospital staff’s workload and their lack of awareness. We aimed to evaluate the relevance of a questionnaire to screen pregnant women for lead exposure. A cross-sectional, multicentre study was carried out on a population of 792 pregnant women from February 2018 to May 2020. A total of 596 women had a blood lead test: 68.5% had blood lead levels below 10 μg/L. The estimated prevalence above 25 µg/L was 4% (95% confidence interval (CI) [2.6–5.9]) and 1.3% had levels above 50 µg/L (95% CI [0.6–2.6]). Multivariate analysis showed that three risk factors significantly increased the probability of blood lead levels above 25 µg/L: the use of traditional cosmetics (adjusted odds ratio [aOR]: 3.90; 95% CI [1.65–9.21]; p = 0.002), degraded old housing (aOR: 2.67; 95% CI [1.19–6.038]; p = 0.018), and (marginally) eating bread more than twice a day (aOR: 2.40; 95% CI [0.96–6.11]; p = 0.060). Our study reveals that a three-question tool can be used to quickly screen for the risk of lead exposure in our population and to trigger lead blood tests and special vigilance during pregnancy follow-up.

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