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Blood lead levels in children with foreign bodies
J F Wiley1, F M Henretig, S M Selbst
1Emergency Department, Children's Hospital of Philadelphia, PA.
Insights
Children with foreign bodies, such as in the ear, nose, or gastrointestinal tract, have higher blood lead levels. Screening for lead poisoning is recommended for these children, especially in inner-city areas.
Area of Science:
- Pediatric Environmental Health
- Toxicology
- Public Health
Background:
- Foreign bodies in children can pose various health risks.
- Lead poisoning remains a significant public health concern, particularly in urban environments.
- Assessing risk factors for lead exposure in vulnerable pediatric populations is crucial.
Purpose of the Study:
- To investigate the association between foreign bodies (aural, nasal, gastrointestinal) and elevated blood lead levels in children.
- To compare lead exposure and poisoning risk in children with foreign bodies versus control groups.
- To inform screening guidelines for lead poisoning in emergency departments.
Main Methods:
- Prospective study design involving 40 children with foreign bodies and two control groups (65 medical clinic, 40 emergency department).
- Measurement of venous blood lead and erythrocyte protoporphyrin levels.
- Questionnaire-based assessment of environmental and behavioral risk factors for lead poisoning.
Main Results:
- Children with foreign bodies exhibited significantly higher mean blood lead levels (P < .001).
- A higher proportion of children with foreign bodies had blood lead levels exceeding 1.2 µmol/L (25 µg/dL) (P < .01).
- Study patients more frequently reported a history of pica or ingestion of a poison compared to medical clinic controls.
Conclusions:
- Inner-city children presenting with foreign bodies face increased lead exposure and a heightened risk of lead poisoning.
- Screening for lead poisoning in the emergency department is recommended for children with foreign bodies in high-prevalence areas.
- Universal lead screening in emergency departments may be warranted for high-risk, inner-city pediatric populations.
Abstract:
To determine the risk of increased blood lead levels in children with aural, nasal, or gastrointestinal foreign bodies, the authors prospectively obtained venous blood lead and erythrocyte protoporphyrin levels from 40 study patients and two control groups without foreign bodies (65 patients presenting to a medical clinic and 40 patients presenting to an emergency department). A questionnaire was used to assess environmental and behavioral risk factors for lead poisoning in the three groups. Mean blood lead level was higher in children with foreign bodies (P less than .001), and they were more likely to have a venous blood lead value of more than 1.2 mumol/L (25 micrograms/dL, P less than .01) than patients in either control group. Seventy-eight percent of study patients had no prior lead screening by parent's report vs 64% of emergency department control subjects and 55% of medical clinic control subjects. Control patients in the emergency department had the same incidence of elevated blood lead values as patients enrolled from the medical clinic (6%). No differences in environmental risk factors were found among the three groups. Study patients more often had a history of pica or ingestion of a poison than control patients from the medical clinic. Inner-city children with foreign bodies have increased lead exposure and may have an increased risk for lead poisoning. In areas of high prevalence of lead poisoning, children with foreign bodies should be screened for lead poisoning in the emergency department. General lead screening in the emergency department may be justified for high-risk, inner-city populations.