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Prevalence of lead exposure in a clinic using 1991 Centers for Disease Control and Prevention recommendations
1Department of Pediatrics, State University of New York Health Science Center, Syracuse 13210.
Insights
Lead poisoning is highly prevalent in young children, with over 25% of those aged 9-24 months exhibiting elevated blood lead levels. Erythrocyte protoporphyrin testing is inadequate for screening, necessitating improved prevention and surveillance strategies.
Area of Science:
- Pediatric Environmental Health
- Toxicology
- Public Health
Background:
- The Centers for Disease Control and Prevention (CDC) updated lead level recommendations in 1991, lowering the acceptable blood lead level to 10 micrograms/dL (0.48 mumol/L).
- Blood lead levels (BLLs) were to be used as the primary screening method for young children.
Purpose of the Study:
- To evaluate the impact of implementing the revised CDC guidelines for lead screening in a pediatric outpatient setting.
- To assess the prevalence of elevated blood lead levels in children aged 9-24 months.
Main Methods:
- A retrospective analysis of 233 children aged 9-24 months seen for well-child visits in 1991.
- Venous blood samples were collected for analysis of blood lead and erythrocyte protoporphyrin (EP) levels.
Main Results:
- 25.5% of children aged 9-12 months and 36.1% of children aged 12-24 months had elevated BLLs (≥10 micrograms/dL).
- EP testing showed poor sensitivity and specificity, with 68.8% of children with elevated EP levels having acceptable BLLs and 33.3% of children with normal EP levels having elevated BLLs.
Conclusions:
- Lead poisoning is highly prevalent in young children within this clinic population.
- EP measurement is an inadequate screening tool for lead poisoning.
- Enhanced primary and secondary prevention efforts, along with repeated screening, are crucial for managing lead exposure in young children.
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 mumol/L (10 micrograms/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 (> or = 0.48 mumol/L) (10 micrograms/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.
