Guidelines for the Identification and Management of Lead Exposure

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EstimateStudy Study of Prenatal Lead Levels Outcome Age atYear Study N ResultsSite Type Exposure (in µg/dL) Measure(s) OutcomeMeasuredAt all ages, infants who hadhigher cord BLLs had lowercrude MDI scores than infantsLongitudinalMean 6.6, SD in the other two groups; thisanalyses of prenatal Development as3.2, range 0-37. relationship was stronger whenand postnatal assessed by theProspective Umbilical Categorized 6, 12, 18, adjusted for covariates. Estimated1987 lead exposure and Boston, MA 182-201 MDI of the Bayleycohort study cord BLL into: low, = 10 4.8 points (95% CI = 2.3, 7.3);(Bellinger et al. 1987)between medium exposure andhigh exposure group was 3.8(95% CI = 1.3, 6.3).In multiple regression analysis, at3 months, MDI decreased by 0.34Maternalfor each increase of 1 µg/dL ofLow-level fetal lead BLL (50%Development as prenatal lead (SE = 0.17, p = 0.05);exposure eff ect on firstassessed by the MDI at 6 months, MDI decreased byneurobehavioral Prospective trimester, Mean 8.0, SD 3 and 61987 Cincinnati, OH 266 and PDI scores of 0.76 for each increase of 1 µg/development in early cohort study 49% 2nd 3.7, range 1-27 monthsthe Bayley Scales of dL of prenatal lead (SE = 0.34, pinfancy (Dietrich et trimester,Infant Development = 0.02). No significant eff ects ofal. 1987) 1% 3rdprenatal lead exposure on PDItrimester)were found after adjustment forcovariates.In multiple regression analysis, at3 months, MDI decreased by 0.6for each increase of 1 µg/dL ofLow-level fetal lead umbilical cord lead (SE = 0.26, p =Development asexposure eff ect on 0.02); at 6 months, MDI decreasedassessed by the MDIneurobehavioral Prospective Umbilical Mean 6.4, SD 3 and 6 by 0.66 for each increase of 1 µg/1987 Cincinnati, OH 96 and PDI scores ofdevelopment in early cohort study cord BLL 4.5, range 1-28 months dL of umbilical cord lead, but wasthe Bayley Scales ofinfancy (Dietrich et not statistically significant at theInfant Developmental. 1987) 0.05 level (SE = 0.37, p = 0.08).No significant eff ects of prenatallead exposure on PDI were foundafter adjustment for covariates.25
EstimateStudy Study of Prenatal Lead Levels Outcome Age atYear Study N ResultsSite Type Exposure (in µg/dL) Measure(s) OutcomeMeasuredBayley MDI and PDILow-level lead and modified KentMaternal BLL was statisticallyexposure in the Infant Developmentsignificantly associated withprenatal and early Maternal Mean 6.5, SD (KID) scale at 6 6 months;Prospective 6 month MDI, PDI, and KID in1987 preschool periods: Cleveland, OH 119-145 BLL (at 1.8, range 2.7 months; Bayley 1, 2, and 3cohort study unadjusted analyses, but theseearly preschool delivery) 11.8 MDI at 1 year and yearsassociations were not significantdevelopment 2 years; Stanfordaftercontrol for covariates.(Ernhart et al. 1987) Binet Intelligencescale at 3 yearsBayley MDI and PDILow-level leadand modified KIDexposure in thescale at 6 months; Umbilical cord BLL was notprenatal and early Mean 5.99, SD 6 months;Prospective Umbilical Bayley MDI at 1 statistically significantly1987 preschool periods: Cleveland, OH 109-127 2.11, range 1, 2, and 3cohort study cord BLL year and 2 years; associated with 6 month or laterearly preschool 2.8-14.7 yearsStanford-Binet MDI, PDI, and KID.developmentIntelligence scale at(Ernhart et al. 1987)3 yearsAbbreviations: 95% CI: 95% confidence interval; BAER: brainstem auditory evoked response; BLL: blood lead level; BSID-II: Bayley Scales of Infant Development; delta-ALA: deltaaminolevulinicacid; FSIQ: full-scale IQ; FTII: Fagan Test of Infant Intelligence; GCI: general cognitive index; HPA: hypothalamic-pituitary-adrenal; KID: Kent Infant Development; K-TEA:Kaufman Test of Educational Achievement; MDI: mental development index; NBAS: Neonatal Behavioral Assessment Scale; OR: odds ratio; PDI: psychomotor development index; PIQ:performance IQ; RR: relative risk; SD: standard deviation; VIQ: verbal IQ; WISC-III IQ: Wechsler Intelligence Scale for Children-version III; WISC-R: Wechsler Intelligence Scale for Children-Revised; WPPSI: Wechsler Preschool and Primary Scale of Intelligence; WPPSI-R IQ: Wechsler Preschool and Primary Scale of Intelligence-Revised.26
Page 1 and 2: GUIDELINES FOR THE IDENTIFICATION A
Page 3 and 4: This document is dedicated to the m
Page 5 and 6: XIV Template for Letter to Construc
Page 8 and 9: EXECUTIVE SUMMARYDespite improvemen
Page 10 and 11: pregnant women with BLL
Page 12 and 13: MEMBERS OF THE WORK GROUP ON LEAD A
Page 14 and 15: MEMBERS OF THE ADVISORY COMMITTEE O
Page 16 and 17: Sally OdlePresident and Owner, Safe
Page 18 and 19: GLOSSARYabatement: any set of measu
Page 20 and 21: cumulative: increasing by successiv
Page 22 and 23: lead-safe work practices: low-techn
Page 24: enovation: construction and/or home
Page 27 and 28: Finally, there is evidence that a s
Page 30 and 31: CHAPTER 2.ADVERSE HEALTH EFFECTS OF
Page 32 and 33: lead exposure (Tabacova et al. 1994
Page 34 and 35: The strongest evidence to date is a
Page 36 and 37: Epidemiologic Evidence for Neurodev
Page 38 and 39: Table 2-1. Summary of Studies Estim
Page 40 and 41: EstimateStudy Study of Prenatal Lea
Page 52 and 53: CHAPTER 3.BIOKINETICS AND B
Page 54 and 55: this biomarker may be a useful rese
Page 56 and 57: Recent studies have documented that
Page 58: Figure 3-1. Major Lead Exposure Pat
Page 61 and 62: Additionally, recent evidence has s
Page 63 and 64: in the study population was 12%
Page 65 and 66: Mobilization of Endogenous Bone Lea
Page 67 and 68: Most of the published literature re
Page 69 and 70: On occasion, imported foods and foo
Page 71 and 72: Case Study 4-3. A Case of Lead Pois
Page 73 and 74: Table 4-1. Risk Factors for Lea
Page 76 and 77: CHAPTER 5.BLOOD LEAD TESTING
Page 78 and 79: Blood Lead Testing in the General P
Page 80 and 81: absorption spectrophotometry (GFAAS
Page 82 and 83: ally, the measured BLL of pregnant
Page 84 and 85: Table 5-2. Schedule for Follow-up B
Page 86 and 87: Figure 5-1. New York City Departmen
Page 88 and 89: CHAPTER 6.MANAGEMENT OF PRE
Page 90 and 91: y providing information to health d
Page 92 and 93: upon eliciting accurate information
Page 94 and 95: tivity that disturbs paint can incr
Page 96 and 97: Case management of pregnant women w
Page 98 and 99: Interpretation and follow-up of blo
Page 100:
Table 6-2. Suggested Factors to Ass
Page 103 and 104:
Decades of laboratory and clinical
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tion of skeletal mineral. Observati
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of follow up, suggesting decreased
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Supplemental Nutrition Program for
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Inadequate vitamin D status is comm
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CHAPTER 8.CHELATION OF PREGNANT
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CLINICAL EVIDENCE IN PREGNANCY AND
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Table 8-1. Chelating Agents Used
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Table 8-3. Published Experience wit
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CHAPTER 9.BREASTFEEDINGKey Consid
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maternal blood exceeds 40 µg/dL (L
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guidance for breastfeeding by women
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Table 9-1. Frequency of Maternal Bl
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Table 9-3. Estimated a Increase in
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CHAPTER 10.RESEARCH, POLICY, AND HE
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Identification and development of n
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Mandatory Reporting of All Adult Bl
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CHAPTER 11. RESOURCES AND REFERRAL
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Offce of Pollution Prevention and T
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Marino PE, Landrigan PJ, Graef J, N
Page 144 and 145:
Dietrich KN, Ris MD, Succop PA, Ber
Page 146 and 147:
McMichael AJ, Vimpani GV, Robertson
Page 148 and 149:
Vigeh M, Yokoyama K, Mazaheri M, Be
Page 150 and 151:
Gulson BL, Jameson CW, Mahaffey KR,
Page 152 and 153:
Satin KP, Neutra RR, Guirguis G, Fl
Page 154 and 155:
Centers for Disease Control and Pre
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Lee MG, Chun OK, Song WO. 2005. Det
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Simpson E, Mull JD, Longley E, East
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Rothenberg SJ, Khan F, Manalo M, Ji
Page 162 and 163:
Piazza C, Fisher W, Hanley G, LeBla
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Godwin HA. 2001. The biological che
Page 166 and 167:
Looker AC, Loyevsky M, Gordeuk VR.
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Willoughby RA, Thirapatsakun T, McS
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Bachrach VR, Schwarz E, Bachrach LR
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U.S. Food and Drug Administration.
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Appendices 149
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Appendix IExisting State Legislatio
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Guidelines for the Identification &
Page 180 and 181:
Appendix IICharge Questions to the
Page 182 and 183:
Page 184 and 185:
Appendix IIICommonly Ingested Subst
Page 186 and 187:
Page 188 and 189:
Appendix IVList of Occupations and
Page 190 and 191:
Page 192 and 193:
Appendix VAlternative Cosmetics, Fo
Page 194 and 195:
Page 196 and 197:
Appendix VIRecommendations for Medi
Page 198 and 199:
Research | Mini-Monograph Recommend
Page 200 and 201:
Recommendations for medical manag
Page 202 and 203:
Recommendations for medical manag
Page 204 and 205:
Recommendations for medical managem
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Recommendations for medical managem
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Appendix VIIMedical Management Guid
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Medical Management Guidelines for L
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Because lead interferes with bioche
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The clinician, with the patient’s
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i.e., at least monthly. In general,
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If elevated maternal blood lead is
Page 220 and 221:
TABLE 2Non-occupational and Environ
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TABLE 4TABLE 4Health Based Health M
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Gulson BL, Mizon KJ, Korsch MJ, Pal
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Appendix VIIIPregnancy Risk Assessm
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EDC:_________________ID:___________
Page 230 and 231:
ID:___________________________B. HO
Page 232 and 233:
ID:___________________________10. I
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ID:___________________________14a.
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ID:___________________________G. NO
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ID:___________________________I. PA
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SUMMARYInstructions: Check all thos
Page 242 and 243:
ID:___________________________APPEN
Page 244 and 245:
Appendix IXAssessment Interview For
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RISK ASSESSMENT INTERVIEW FORMDate:
Page 248 and 249:
Appendix XLead Based Paint Risk Ass
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Lead-Based Paint Risk Assessment Re
Page 252 and 253:
(Use one of the following sentences
Page 254 and 255:
Appendix ATesting Locations229
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Appendix CDust Wipe and Soil Sample
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Appendix XIPrimary Prevention Infor
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LI #:NEW YORK CITY DEPARTMENT OF HE
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LI #:8a. If yes >> Please tell me h
Page 264 and 265:
Appendix XIIChild Risk Assessment F
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CHILD ID: Page 1 of 12PNEW YORK CIT
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CHILD ID: Page 3 of 126. Does [chil
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CHILD ID: Page 5 of 1217a. If yes >
Page 272 and 273:
CHILD ID: Page 7 of 1224. [Imported
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CHILD ID: Page 9 of 12Home renovati
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CHILD ID: Page 11 of 12Provide the
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Appendix XIIINutritional Reference
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Nutrition Reference InformationRECO
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Blood hemoglobin levels are routine
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Beef, chuck, blade roast, lean, coo
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Sunflower oil, 1 TbspCottonseed oil
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Appendix XIVTemplate for Letter to
Page 290 and 291:
Template for Letter to Construction
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Appendix XVWorkplace Hazard Alert f
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WORKPLACE HAZARD ALERTNew Health Da
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What should I tell my doctor?Your d
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Make sure you don’t accidentally
Page 300 and 301:
Worksite Evaluation FormWhat your e
Page 302:
CS2016857
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Guidelines for the Identification and Management of Lead Exposure

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