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Prevalence of Lead Exposure in a Clinic Using 1991 Centers for Disease Control and Prevention Recommendations

Prevalence of Lead Exposure in a Clinic Using 1991 Centers for Disease Control and Prevention... Abstract • Objective. —To determine the effects of applying the October 1991 recommendations of the Centers for Disease Control and Prevention to lower the acceptable blood lead level to 0.48 μmol/L (10 μg/dL) and to use blood lead levels as the primary method of screening in young children. Design —Retrospective patient series. Setting. —Outpatient pediatric department in a university hospital. Participants. —Two hundred thirty-three children between the ages of 9 and 24 months presenting at well-child visits during 1991. Selection Procedures. —Consecutive children. Interventions. —None. Measurements and Results. —All children underwent venous sampling for measurement of blood lead and erythrocyte protoporphyrin levels. Of 78 children aged 9 to 12 months, and 155 children aged 12 to 24 months, 25.5% and 36.1%, respectively, had elevated blood lead levels (≥0.48 μmol/L) (10 μg/dL). Of the 80 children with elevated levels of erythrocyte protoporphyrin, 55 (68.8%) had acceptable blood lead levels. Of 153 children with normal levels of erythrocyte protoporphyrin, 51 (33.3%) had elevated blood lead levels. Conclusions. —These data demonstrate the high prevalence in our clinic of lead poisoning among children aged 9 to 12 months and 12 to 24 months. Measurement of erythrocyte protoporphyrin has poor sensitivity and specificity and is no longer an adequate screening test. Greater efforts at primary and secondary prevention of lead poisoning are needed for young children. Repeated screening is necessary to identify those who would benefit from increased surveillance and intervention.(AJDC. 1993;147:761-763) References 1. Lin-Fu JS. Vulnerability of children to lead exposure and toxicity . N Engl J Med . 1973;289:1229-1233.Crossref 2. Centers for Disease Control. Increased Lead Absorption and Lead Poisoning in Young Children: A Statement by the Centers for Disease Control . Atlanta, Ga: US Dept of Health and Human Services; 1975. 3. Centers for Disease Control. Preventing Lead Poisoning in Young Children: A Statement by the Centers for Disease Control . Atlanta, Ga: US Dept of Health and Human Services; 1985. 4. Centers for Disease Control. Preventing Lead Poisoning in Young Children: A Statement by the Centers for Disease Control . Atlanta, Ga: US Dept of Health and Human Services; 1991. 5. Melman ST, Christiansen D, Schorr MD. Majority of children in an inner-city clinic population have lead levels exceeding the Centers for Disease Control revised intervention threshold . AJDC . 1992;146:477. 6. Nelson DB, Cox JM, Richmond D, Toporowicz M, Zuckerman A. Lead poisoning in a non–inner city practice . AJDC . 1992;146:478. 7. Sadowitz PD, Oski FA. Iron status and infant feeding practices in an urban ambulatory center . Pediatrics . 1983;72:33-36. 8. Tunnessen WW, Oski FA. Consequences of starting whole cow milk at 6 months of age . J Pediatr . 1987;111:813-816.Crossref 9. Blatt SD, Weinberger HL, Burdick MP, Mintz HP, Klineberg SS. High prevalence of elevated free erythrocyte protoporphyrin in Onondaga County. Presented at the Fifth Annual Charles R. Ross Research Poster Session; December 4, 1991; Syracuse, NY. 10. Bellinger D, Sloman J, Leviton A, Rabinowitz M, Needleman HL, Waternaux C. Low-level lead exposure and children's cognitive function in the preschool years . Pediatrics . 1991;87:219-227. 11. Lewis M, Worobey J, Ramsay DS, McCormack MK. Prenatal exposure to heavy metals: effect on childhood cognitive skills and health status . Pediatrics . 1992;89:1010-1015. 12. Shannon MW, Graef JW. Lead intoxication in infancy . Pediatrics . 1992;89:87-90. 13. Needleman HL, Gunnoe C, Leviton A, et al. Deficits in psychologic and classroom performance of children with elevated dentine lead levels . N Engl J Med . 1979;300:689-695.Crossref 14. Needleman HL, Schell A, Bellinger D, Leviton A, Allred EN. The long-term effects of exposure to low doses of lead in childhood: an 11-year follow-up report . N Engl J Med . 1990;322:83-88.Crossref 15. Baghurst PA, McMichael AJ, Wigg NR, et al. Environmental exposure to lead and children's intelligence at the age of seven years . N Engl J Med . 1992;327:1279-1284.Crossref 16. Oski FA, Honig AS. The effects of on the developmental scores of iron-deficient infants . J Pediatr . 1978;92:21-25.Crossref 17. Oski FA, Honig AS, Helu B, Howanitz P. Effect of iron therapy on behavior performance in nonanemic, iron-deficient infants . Pediatrics . 1983; 71:877-880. 18. Lozoff B, Brittenham G, Wolf A, et al. Iron deficiency anemia and iron therapy effects on infant developmental test performance . Pediatrics . 1987; 79:981-995. 19. Lozoff B, Jimenez E, Wolf A. Long-term developmental outcome of infants with iron deficiency . N Engl J Med . 1991;325:687-694.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png American Journal of Diseases of Children American Medical Association

Prevalence of Lead Exposure in a Clinic Using 1991 Centers for Disease Control and Prevention Recommendations

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References (22)

Publisher
American Medical Association
Copyright
Copyright © 1993 American Medical Association. All Rights Reserved.
ISSN
0002-922X
DOI
10.1001/archpedi.1993.02160310063019
Publisher site
See Article on Publisher Site

Abstract

Abstract • Objective. —To determine the effects of applying the October 1991 recommendations of the Centers for Disease Control and Prevention to lower the acceptable blood lead level to 0.48 μmol/L (10 μg/dL) and to use blood lead levels as the primary method of screening in young children. Design —Retrospective patient series. Setting. —Outpatient pediatric department in a university hospital. Participants. —Two hundred thirty-three children between the ages of 9 and 24 months presenting at well-child visits during 1991. Selection Procedures. —Consecutive children. Interventions. —None. Measurements and Results. —All children underwent venous sampling for measurement of blood lead and erythrocyte protoporphyrin levels. Of 78 children aged 9 to 12 months, and 155 children aged 12 to 24 months, 25.5% and 36.1%, respectively, had elevated blood lead levels (≥0.48 μmol/L) (10 μg/dL). Of the 80 children with elevated levels of erythrocyte protoporphyrin, 55 (68.8%) had acceptable blood lead levels. Of 153 children with normal levels of erythrocyte protoporphyrin, 51 (33.3%) had elevated blood lead levels. Conclusions. —These data demonstrate the high prevalence in our clinic of lead poisoning among children aged 9 to 12 months and 12 to 24 months. Measurement of erythrocyte protoporphyrin has poor sensitivity and specificity and is no longer an adequate screening test. Greater efforts at primary and secondary prevention of lead poisoning are needed for young children. Repeated screening is necessary to identify those who would benefit from increased surveillance and intervention.(AJDC. 1993;147:761-763) References 1. Lin-Fu JS. Vulnerability of children to lead exposure and toxicity . N Engl J Med . 1973;289:1229-1233.Crossref 2. Centers for Disease Control. Increased Lead Absorption and Lead Poisoning in Young Children: A Statement by the Centers for Disease Control . Atlanta, Ga: US Dept of Health and Human Services; 1975. 3. Centers for Disease Control. Preventing Lead Poisoning in Young Children: A Statement by the Centers for Disease Control . Atlanta, Ga: US Dept of Health and Human Services; 1985. 4. Centers for Disease Control. Preventing Lead Poisoning in Young Children: A Statement by the Centers for Disease Control . Atlanta, Ga: US Dept of Health and Human Services; 1991. 5. Melman ST, Christiansen D, Schorr MD. Majority of children in an inner-city clinic population have lead levels exceeding the Centers for Disease Control revised intervention threshold . AJDC . 1992;146:477. 6. Nelson DB, Cox JM, Richmond D, Toporowicz M, Zuckerman A. Lead poisoning in a non–inner city practice . AJDC . 1992;146:478. 7. Sadowitz PD, Oski FA. Iron status and infant feeding practices in an urban ambulatory center . Pediatrics . 1983;72:33-36. 8. Tunnessen WW, Oski FA. Consequences of starting whole cow milk at 6 months of age . J Pediatr . 1987;111:813-816.Crossref 9. Blatt SD, Weinberger HL, Burdick MP, Mintz HP, Klineberg SS. High prevalence of elevated free erythrocyte protoporphyrin in Onondaga County. Presented at the Fifth Annual Charles R. Ross Research Poster Session; December 4, 1991; Syracuse, NY. 10. Bellinger D, Sloman J, Leviton A, Rabinowitz M, Needleman HL, Waternaux C. Low-level lead exposure and children's cognitive function in the preschool years . Pediatrics . 1991;87:219-227. 11. Lewis M, Worobey J, Ramsay DS, McCormack MK. Prenatal exposure to heavy metals: effect on childhood cognitive skills and health status . Pediatrics . 1992;89:1010-1015. 12. Shannon MW, Graef JW. Lead intoxication in infancy . Pediatrics . 1992;89:87-90. 13. Needleman HL, Gunnoe C, Leviton A, et al. Deficits in psychologic and classroom performance of children with elevated dentine lead levels . N Engl J Med . 1979;300:689-695.Crossref 14. Needleman HL, Schell A, Bellinger D, Leviton A, Allred EN. The long-term effects of exposure to low doses of lead in childhood: an 11-year follow-up report . N Engl J Med . 1990;322:83-88.Crossref 15. Baghurst PA, McMichael AJ, Wigg NR, et al. Environmental exposure to lead and children's intelligence at the age of seven years . N Engl J Med . 1992;327:1279-1284.Crossref 16. Oski FA, Honig AS. The effects of on the developmental scores of iron-deficient infants . J Pediatr . 1978;92:21-25.Crossref 17. Oski FA, Honig AS, Helu B, Howanitz P. Effect of iron therapy on behavior performance in nonanemic, iron-deficient infants . Pediatrics . 1983; 71:877-880. 18. Lozoff B, Brittenham G, Wolf A, et al. Iron deficiency anemia and iron therapy effects on infant developmental test performance . Pediatrics . 1987; 79:981-995. 19. Lozoff B, Jimenez E, Wolf A. Long-term developmental outcome of infants with iron deficiency . N Engl J Med . 1991;325:687-694.Crossref

Journal

American Journal of Diseases of ChildrenAmerican Medical Association

Published: Jul 1, 1993

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