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Lead intoxication in infancy
1Division of Emergency Medicine, Children's Hospital, Boston, MA 02115.
Insights
Lead intoxication in infants is common, with unique sources like contaminated water and household renovation, differing from toddlers. Early detection and management are crucial for infant health.
Area of Science:
- Pediatrics
- Environmental Health
- Toxicology
Background:
- Lead intoxication poses significant risks to young children's development.
- Mandatory lead screening in Massachusetts identifies a notable number of infants with elevated lead levels.
Purpose of the Study:
- To analyze the characteristics and sources of lead intoxication in infants under 12 months.
- To compare infant lead exposure origins with those in older children (18-30 months).
Main Methods:
- Retrospective review of 50 infants (≤12 months) in a lead referral program.
- Comparison with 47 toddlers (18-30 months) from the same program.
- Analysis of lead levels, erythrocyte protoporphyrin, and identified exposure sources.
Main Results:
- Infants presented with a mean peak lead level of 39.0 µg/dL.
- Common infant exposure sources included household renovation (20), paint chips (10), and contaminated water (9).
- Toddlers primarily ingested paint chips (41) or were exposed during renovation (2).
Conclusions:
- Infant lead intoxication is prevalent and stems from different sources than in toddlers.
- Environmental factors like renovation and contaminated water are key infant exposure routes.
- Understanding these distinct origins is vital for targeted prevention strategies in infants.
Abstract:
Four years of experience in the evaluation and management of lead intoxication in the first year of life were reviewed. This study was conducted in a lead referral program within the state of Massachusetts, whose comprehensive lead laws include extensive (and now mandatory) lead screening of all children. Over the period of study, 50 (14%) of 370 new patients enrolled in the program were infants aged 12 months or younger. Median age of these infants was 11 months (range 1 through 12 months). Mean peak lead level was 39.0 micrograms/dL while the mean peak erythrocyte protoporphyrin concentration was 111.9 micrograms/dL of whole blood. Thirty-two percent of infants were ambulatory at the time lead intoxication was diagnosed; only 24% had a history of pica. Twenty-six percent of parents were welfare dependent. Apparent sources of plumbism included house-hold renovation (n = 20), direct ingestion of paint chips (n = 10), formula preparation with lead-contaminated water (n = 9), lead dust importation (n = 1), and congenital exposure to elevated maternal lead level (n = 1). In 9 cases the source was not found. When this profile was compared with that of a randomly selected group of 47 children aged 18 through 30 months, who were seen in the lead program during the same interval, apparent sources of intoxication in the older group were paint chip ingestion (n = 41), household renovation (n = 2), and unknown (n = 4) (P less than .0001). On the basis of these data, it is concluded that lead intoxication in infants is common and has significantly different origins from that in toddlers.(ABSTRACT TRUNCATED AT 250 WORDS)