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. 1996 Sep;104(9):968–972. doi: 10.1289/ehp.96104968

Moderate lead poisoning: trends in blood lead levels in unchelated children.

M E Markowitz 1, P E Bijur 1, H A Ruff 1, K Balbi 1, J F Rosen 1
PMCID: PMC1469468  PMID: 8899376

Abstract

The appropriate clinical management of children who are moderately poisoned with lead (Pb) is under active investigation. To determine the pattern of change in blood Pb (BPb) levels in the absence of chelation therapy, we followed moderately Pb-poisoned children (initial blood Pb levels 1.21-2.66 mumol/l or 25-55 micrograms/dl) for 6 months with repeated BPb level measurements. Chelation therapy was not administered because all the children had negative lead mobilization tests indicating limited response to the chelating agent, calcium disodium edetate (CaNa2EDTA). Eligible children received the following interventions: notification of the health department to remediate lead hazards; reinforced educational efforts about the toxicity sources and treatment of Pb during 10 clinic and 3 home visits; and iron therapy for children with ferritin levels less than 16 micrograms/l. To quantify the lead paint hazards in the home, we combined a visual rating of the surfaces (intact to peeling) with an X-ray fluorescence (XRF) measurement of the lead content of the painted surface. The sum of these assessments is termed the home environmental score (HES). Data were analyzed from 79 children. BPb levels declined by 27%, on average, over 6 months. HES was correlated with BPb at enrollment, but neither the initial nor later HES measurements predicted BPb at other time points. The HES was highest at enrollment and declined by 50% and 75% at the second and third home visits, respectively. However, only a minority of the children (20%) achieved an HES of 0, indicating no lead paint hazards at home. Despite some ongoing Pb exposure, a parallel fall in BPb levels was observed in subgroups of children with either initially low or high HES (above or below the median HES of 37). Iron status did not account for the change in BPb levels. These data provide evidence that our measure, the HES, is quantifiably related to BPb levels in children, that this correlation is significant only prior to intervention; and that BPb levels decline in children who are moderately poisoned with Pb after they are enrolled in a comprehensive intervention program, even in the absence of chelation therapy and in the presence of ongoing lead paint exposure and Fe deficiency.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Alexander L. M., Heaven A., Delves H. T., Moreton J., Trenouth M. J. Relative exposure of children to lead from dust and drinking water. Arch Environ Health. 1993 Nov-Dec;48(6):392–400. doi: 10.1080/00039896.1993.10545960. [DOI] [PubMed] [Google Scholar]
  2. Amitai Y., Brown M. J., Graef J. W., Cosgrove E. Residential deleading: effects on the blood lead levels of lead-poisoned children. Pediatrics. 1991 Nov;88(5):893–897. [PubMed] [Google Scholar]
  3. Barton J. C., Conrad M. E., Nuby S., Harrison L. Effects of iron on the absorption and retention of lead. J Lab Clin Med. 1978 Oct;92(4):536–547. [PubMed] [Google Scholar]
  4. Charney E., Kessler B., Farfel M., Jackson D. Childhood lead poisoning. A controlled trial of the effect of dust-control measures on blood lead levels. N Engl J Med. 1983 Nov 3;309(18):1089–1093. doi: 10.1056/NEJM198311033091804. [DOI] [PubMed] [Google Scholar]
  5. Dietrich K. N., Berger O. G., Succop P. A. Lead exposure and the motor developmental status of urban six-year-old children in the Cincinnati Prospective Study. Pediatrics. 1993 Feb;91(2):301–307. [PubMed] [Google Scholar]
  6. Farfel M. R., Chisolm J. J., Jr Health and environmental outcomes of traditional and modified practices for abatement of residential lead-based paint. Am J Public Health. 1990 Oct;80(10):1240–1245. doi: 10.2105/ajph.80.10.1240. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Klein M. C., Schlageter M. Non-treatment of screened children with intermediate blood lead levels. Pediatrics. 1975 Aug;56(2):298–302. [PubMed] [Google Scholar]
  8. Mahaffey K. R., Annest J. L., Roberts J., Murphy R. S. National estimates of blood lead levels: United States, 1976-1980: association with selected demographic and socioeconomic factors. N Engl J Med. 1982 Sep 2;307(10):573–579. doi: 10.1056/NEJM198209023071001. [DOI] [PubMed] [Google Scholar]
  9. Markowitz M. E., Bijur P. E., Ruff H., Rosen J. F. Effects of calcium disodium versenate (CaNa2EDTA) chelation in moderate childhood lead poisoning. Pediatrics. 1993 Aug;92(2):265–271. [PubMed] [Google Scholar]
  10. Markowitz M. E., Rosen J. F. Assessment of lead stores in children: validation of an 8-hour CaNa2EDTA provocative test. J Pediatr. 1984 Mar;104(3):337–341. doi: 10.1016/s0022-3476(84)81091-4. [DOI] [PubMed] [Google Scholar]
  11. Markowitz M. E., Rosen J. F., Bijur P. E. Effects of iron deficiency on lead excretion in children with moderate lead intoxication. J Pediatr. 1990 Mar;116(3):360–364. doi: 10.1016/s0022-3476(05)82821-5. [DOI] [PubMed] [Google Scholar]
  12. McCusker J. Longitudinal changes in blood lead level in children and their relationship to season, age, and exposure to paint or plaster. Am J Public Health. 1979 Apr;69(4):348–352. doi: 10.2105/ajph.69.4.348. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. McMichael A. J., Baghurst P. A., Robertson E. F., Vimpani G. V., Wigg N. R. The Port Pirie cohort study. Blood lead concentrations in early childhood. Med J Aust. 1985 Nov 25;143(11):499–503. [PubMed] [Google Scholar]
  14. Reigart J. R., Whitlock N. H. Longitudinal observations of the relationship between free erythrocyte porphyrins and whole blood lead. Pediatrics. 1976 Jan;57(1):54–59. [PubMed] [Google Scholar]
  15. Ruff H. A., Bijur P. E., Markowitz M., Ma Y. C., Rosen J. F. Declining blood lead levels and cognitive changes in moderately lead-poisoned children. JAMA. 1993 Apr 7;269(13):1641–1646. [PubMed] [Google Scholar]
  16. Staes C., Matte T., Copley C. G., Flanders D., Binder S. Retrospective study of the impact of lead-based paint hazard remediation on children's blood lead levels in St. Louis, Missouri. Am J Epidemiol. 1994 May 15;139(10):1016–1026. doi: 10.1093/oxfordjournals.aje.a116941. [DOI] [PubMed] [Google Scholar]
  17. Watson W. S., Hume R., Moore M. R. Oral absorption of lead and iron. Lancet. 1980 Aug 2;2(8188):236–237. doi: 10.1016/s0140-6736(80)90124-5. [DOI] [PubMed] [Google Scholar]

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