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[Lead poisoning in children. Apropos of 129 cases]
A Yver1, G Leverger, J L Iniguez
1l'Unité d'Hématologie et d'Oncologie Pédiatrique, Hôpital Trousseau, Paris.
Insights
This study shows that chelation therapy effectively reduces blood lead levels in children with chronic lead poisoning. Treatment improved the classification of 80% of severe cases, preventing acute effects.
Area of Science:
- Pediatric Toxicology
- Environmental Health
- Clinical Chemistry
Context:
- Chronic lead poisoning in children is a significant public health concern.
- Old lead paint ingestion (pica) was identified as the primary source of exposure.
- Children were categorized into four classes based on blood lead levels (CDC 1985).
Purpose:
- To evaluate the effectiveness of chelation therapy (BAL + EDTA, EDTA) in treating chronic childhood lead poisoning.
- To assess the reduction in blood lead levels and clinical classification changes post-treatment.
- To investigate the combined impact of medical and sociocultural interventions.
Summary:
- 129 children with chronic lead poisoning were treated. Severe cases (Class IV) receiving BAL + EDTA or EDTA alone showed significant blood lead level reductions (50-52%).
- Overall, 80% of Class IV children improved to Class I or II after treatment.
- Class II children also showed improvement with EDTA treatment, with 8 studied cases moving to Class I or II.
Impact:
- Chelation therapy, combined with screening and sociocultural approaches, successfully mitigated acute effects of severe lead poisoning.
- The long-term efficacy of this comprehensive approach in preventing chronic sequelae requires further investigation.
Abstract:
One hundred and twenty nine children with chronic lead poisoning were followed from August 1985 to July 1989. Old lead paint was recognized as the contaminant source at home. Pica of paint flakes was the main mode of intoxication. Children were classified according to the Center for Disease Control 1985 as follows: class IV (39 cases), class III (45 cases), class II (30 cases), class I (15 cases). Nineteen of those in class IV had blood lead levels above 700 micrograms/l and received BAL + EDTA followed by EDTA alone for a mean of 4.6 +/- 3.5 courses. With this treatment, blood lead level decreases were 50 +/- 17%. Nine of these class IV children had an evaluation at last 3 months after the last chelation course: 5 became class I or II, and 2 class III with a negative provocative test. The remaining 20 children in class IV were given a mean of 2.7 +/- 1.4 courses of EDTA. Blood lead levels decreased by 52 +/- 15%; 11 children were evaluable at least 3 months after the last chelation course: 4 became class I, and 7 class II. Thus overall 80% of class IV moved under treatment to class I or II. Among those 45 children in class II, 30 underwent a provocative test and 24 one to three courses of EDTA: 8 were further studied: 3 became class I and 5 class II. Combination of screening, medical treatment and sociocultural approach led to avoid acute effects of severe chronic childhood lead poisoning. The efficacy of such an approach in preventing chronic effects has still to be evaluated.