Prevalence of lead exposure in a clinic using 1991 Centers for Disease Control and Prevention recommendations
S. D. Blatt and H. L. Weinberger
Department of Pediatrics, State University of New York Health Science Center, Syracuse 13210.
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.
