Putting Guide line s into Prac tic e Je r ome A. Paulson, MD, F - - PowerPoint PPT Presentation

▶
putting guide line s into prac tic e
SMART_READER_LITE
LIVE PREVIEW

Putting Guide line s into Prac tic e Je r ome A. Paulson, MD, F - - PowerPoint PPT Presentation

Oct 26, 2023 273 likes •504 views

NG in the 21 st Ce ntury L E AD POI SONI Putting Guide line s into Prac tic e Je r ome A. Paulson, MD, F AAP Pro fe sso r o f Pe dia tric s & E nviro nme nta l & Oc c upa tio na l He a lth Ge o rg e Washing to n Unive rsity

slide-1
SLIDE 1

1

Putting Guide line s into Prac tic e

Je r

  • me A. Paulson, MD, F

AAP

Pro fe sso r o f Pe dia tric s & E nviro nme nta l & Oc c upa tio na l He a lth Ge o rg e Washing to n Unive rsity Me dic a l Dire c to r fo r Na tio na l & Glo b a l Affa irs Child He a lth Advo c a c y I nstitute Dire c to r, Mid-Atla ntic Ce nte r fo r Childre n’ s He a lth & the E nviro nme nt Childre n’ s Natio nal Me dic al Ce nte r

L E AD POI SONI NG in the 21st Ce ntury

slide-2
SLIDE 2

2

  • T

his ma te ria l wa s de ve lo pe d b y the Mid-Atla ntic Ce nte r fo r Childre n’ s He a lth & the E nviro nme nt a nd funde d unde r the c o o pe ra tive a g re e me nt a wa rd numb e r 1U61T S000118-03 fro m the Ag e nc y fo r T

  • xic

Sub sta nc e s a nd Dise a se Re g istry (AT SDR).

  • Ac kno wle dg e me nt: T

he U.S. E nviro nme nta l Pro te c tio n Ag e nc y (E PA) suppo rts the PE HSU b y pro viding funds to AT SDR unde r I nte r-Ag e nc y Ag re e me nt numb e r DW-75-92301301-0. Ne ithe r E PA no r AT SDR e ndo rse the purc ha se o f a ny c o mme rc ia l pro duc ts o r se rvic e s me ntio ne d in PE HSU pub lic a tio ns.

  • Dr. Pa ulso n ha s c o nsulte d with la wye rs in le a d

po iso ning c a se s

Disc lo sure s

slide-3
SLIDE 3

3

  • Afte r a tte nding this se ssio n the pa rtic ipa nt

will b e a b le to

– disc uss why le a d po iso ning is still a pro b le m – disc uss the e xte nt o f le a d po iso ning in the US – e xpla in the impo rta nc e o f prima ry pre ve ntio n – utilize pe dia tric e nviro nme nta l he a lth spe c ia lty

units a s a c linic a l a nd e duc a tio na l a id

OBJE CT I VE S

slide-4
SLIDE 4

4

  • Ha ve the po te ntia l to e limina te c hildho o d

le a d po iso ning

– le a st 4 millio n ho use ho lds ha ve c hildre n living in

the m tha t a re b e ing e xpo se d to le a d

– Ab o ut 500,000 c hildre n with b lo o d le a d le ve ls

  • ve r 5 µg / dL

Sc o pe o f the Pro b le m

http://www.cdc.gov/nceh/lead/

slide-5
SLIDE 5

5

Pr imar y Pr e ve ntion is the Only Appr

  • pr

iate Appr

  • ac h to the Re solution
  • f the L

e ad Poisoning Pr

  • ble m
  • Sc re e ning o f c hildre n ma y ha ve b e e n

a ppro pria te in the pa st & must c o ntinue until…

  • Ma king ho using le a d -sa fe is wha t is

a ppro pria te no w a nd in the future

slide-6
SLIDE 6

6

  • Mo st re c e nt CDC do c ume nt – June 2012
  • “E

limina tio n o f the use o f the te rm “b lo o d le a d le ve l o f c o nc e rn” b a se d o n the c o mpe lling e vide nc e tha t lo w BL L s a re a sso c ia te d with I Q de fic its, a tte ntio n-re la te d b e ha vio rs, a nd po o r a c a de mic a c hie ve me nt.”

  • T

he a b se nc e o f a n ide ntifie d BL L witho ut de le te rio us e ffe c ts, c o mb ine d with the e vide nc e tha t the se e ffe c ts a ppe a r to b e irre ve rsib le , unde rsc o re s the c ritic a l impo rta nc e

  • f prima ry pre ve ntio n.

“L

  • w L

e ve l L e a d E xpo sure Ha rms Childre n: A Re ne we d Ca ll o f Prima ry Pre ve ntio n”

slide-7
SLIDE 7

7

Blo o d L e a d L e ve l fo r Childre n Ag e d 1-5 Ye a rs b y Ye a r o f NHANE S, US

Centers for Disease Control. (2012). Fourth National Report on Human Exposure to Environmental Chemicals: Updated Tables September 2012. Accessed at: http://www.cdc.gov/exposurereport/ Jones, R., Homa, D., Meyer, P., Brody, D., Caldwell, K., Pirkle, J., & Brown, M. (2009). Trends in blood lead levels and blood lead testing among US children aged 1 to 5 years, 1988-2004. Pediatrics, 123(3), e376-e385. doi:10.1542/peds.2007-3608 Mahaffey KR, Annest JL, Roberts J, Murphy RS. National estimates of blood lead levels: United States, 1976-1980. N Engl J Med 1982;307:573-9.
slide-8
SLIDE 8

8

Whe re Did Suc c e ss I n L

  • we ring L

e a d L e ve ls Co me F ro m?

  • Gasoline
  • Paint
  • Cans
  • Water
  • Ceramics

http://www.epa.gov/bns/lead/Fig_01.gif

slide-9
SLIDE 9

9

  • Old pa int
  • L

e a d o n the g ro und

– F

ro m pa int

– F

ro m pa st use o f le a de d g a so line

– I

ndustria l so urc e s – sme lte rs

– So lde r

  • As le a d pa int b e c o me s le ss c o mmo n,

“Othe r” b e c o me s pro po rtio na te ly mo re impo rta nt Ho w Do Childre n Ge t L e a d Po iso ne d T

  • da y?
slide-10
SLIDE 10

10

  • L

e a d g la ze d po tte ry

  • Bra ss fitting s in we ll pumps
  • L

e a d wa te r pipe s

  • I

mpo rte d ho me re me die s, c o sme tic s, spic e s, a yurve dic me dic a tio ns

  • F

iring ra ng e s

  • Auto mo tive re pa ir
  • Ca sting a mmunitio n, fishing we ig hts o r sinke rs
  • Burning le a d pa inte d wo o d o r le a d b a tte rie s

Othe r Po te ntia l So urc e s Of L e a d I n T he E nviro nme nt

slide-11
SLIDE 11

11

  • L
  • we rs I

Q

– I

ndividua l impa c t sma ll - a b o ut 4 I Q po ints fo r b lo o d le a d le ve ls o f 2.4-10 mc g / dL

– Po pula tio n impa c t ve ry sig nific a nt

  • Qua druple risk o f I

Q < 80: 16% vs. 4%

  • 5% o f lo w le a ds with I

Q > 125, O% o f hig h le a ds.

Ne uro b e ha vio ra l E ffe c ts o f “L

  • w” L

e a d L e ve ls

slide-12
SLIDE 12

12

Sma ll I ndividua l E ffe c ts Ca n Ha ve L a rg e Po pula tio n E ffe c ts

Weiss B. Neurotoxicology. 1997;18:581–6. 57% increase in “Intellectually Impaired “Population

slide-13
SLIDE 13

13

High Lifetime Mean Blood Lead (26 µg/dL) Low Lifetime Mean Blood Lead (7.6 µg/dL)

Ac tiva tio n in le ft fro nta l c o rte x, a dja c e nt to Bro c a 's a re a , a nd le ft middle te mpo ra l g yrus, inc luding We rnic ke 's a re a , we re fo und to b e sig nific a ntly a sso c ia te d with diminishe d a c tiva tio n in sub je c ts with hig he r me a n c hildho o d b lo o d le a d le ve ls, whe re a s the c o mpe nsa to ry a c tiva tio n in the rig ht he misphe re ho mo lo g

  • f We rnic ke 's a re a

wa s e nha nc e d in sub je c ts with hig he r b lo o d le a d le ve ls. Yua n, e t a l. 2006

Childho o d le a d e xpo sure ha s a sig nific a nt a nd pe rsiste nt impa c t

  • n b ra in o rg a niza tio n a sso c ia te d with la ng ua g e func tio n
slide-14
SLIDE 14

14

5 µg/ dL

Wha t I s T he Curre nt Blo o d L e a d Re fe re nc e Va lue ?

slide-15
SLIDE 15

15

  • T

his is a 2-ye a r o ld Hispa nic ma le who ha d a b lo o d le a d le ve l o f 42 mc g / dL

  • n a ro utine

sc re e ning te st.

  • Wha t do yo u wa nt to kno w?

Ca se 1

slide-16
SLIDE 16

16

  • Whe re do e s he live ?
  • Ho w o ld is the ho me ?
  • I

s the re a ny le a d in the wa te r?

  • Wha t o the r e xpo sure s c o uld the re b e ?

Ca se 1

slide-17
SLIDE 17

17

  • Po ssib le e xpo sure so urc e s in Hispa nic

fa milie s

– c a ndy pro duc e d in Me xic o (ta ma rind c a ndy) – po tte ry – fo lk re me die s use d in so me Hispa nic ho use ho lds

to tre a t "e mpa c ho ,"

  • le a d o xide , a ye llo w-o ra ng e po wde r (g re ta ),
  • le a d te tro xide , a b rig ht o ra ng e po wde r (a za rc o n(a lso

kno wn a s re uda , lig a , c o ra l, a la rc o n a nd ma ria luisa )

Ca se 1

  • CDC. Lead Poisoning Associated with Ayurvedic Medications---Five States, 2000--2003. MMWR. July 9, 2004; 53(26):582-584.
slide-18
SLIDE 18

18

  • Clinic ia ns sho uld b e a re lia b le so urc e o f

info rma tio n o n le a d ha za rds a nd ta ke the prima ry ro le in e duc a ting fa milie s a b o ut pre ve nting le a d e xpo sure s. T his inc lude s re c o mme nding e nviro nme nta l a sse ssme nts PRI OR to b lo o d le a d sc re e ning o f c hildre n a t risk fo r le a d e xpo sure . Ro le o f Prima ry Ca re Pe dia tric ia n

CDC Re spo nse to Ad viso ry Co mmitte e o n Child ho o d L e a d Po iso ning Pre ve ntio n Re c o mme nd a tio ns in “L

  • w L

e ve l L e ad E xpo sur e Har ms Childr e n: A Re ne we d Call

  • f Pr

imar y Pr e ve ntio n” 05-12

slide-19
SLIDE 19

19

  • BL

L < 5 mc g/ dL

–

Re vie w la b r e sults with fa mily. F

  • r re fe re nc e , the g e o me tric me a n b lo o d le a d

le ve l fo r c hild re n 1-5 ye a rs o ld is le ss tha n 2 mc g / d L .

–

Re pe a t the blood le a d le ve l in 6-12 months if the c hild is a t hig h r isk or r isk c ha ng e s dur ing the time fr a me . E

nsure le ve ls a re d o ne a t 1 a nd 2 ye a rs o f a g e .

–

F

  • r

c hildr e n sc r e e ne d a t a g e < 12 months, c onside r r e te sting in 3-6 months a s le a d e xposur e ma y inc r e a se a s mobility inc r e a se s.

–

Pe r for m r

  • utine he a lth ma inte na nc e inc lud ing a sse ssme nt o f nutritio n, physic a l

a nd me nta l d e ve lo pme nt, a s we ll a s iro n d e fic ie nc y risk fa c to rs.

–

Pr

  • vide a ntic ipa tor

y g uida nc e on c ommon sour c e s of e nvir

  • nme nta l le a d

e xposur e : pa int in ho me s b uilt prio r to 1978, so il ne a r ro a d wa ys o r o the r

so urc e s o f le a d , ta ke -ho me e xpo sure s re la te d to a d ult o c c upa tio ns, impo rte d spic e s, c o sme tic s, fo lk re me d ie s, a nd c o o kwa re .

PE HSUs’ Re c o mme nda tio ns fo r Ope ra tio na lizing the Ne w CDC Re c o mme nda tio ns

slide-20
SLIDE 20

20

  • BL

L 5- 14 mc g/ dL

–

Pe r for m ste ps a s de sc r ibe d a bove for le ve ls < 5 mc g / dL .

–

Re -te st ve nous blood le a d le ve l within 1-3 months a nd the n if sta b le o r

d e c re a sing , in 3 mo nths. Re fe r pa tie nt to lo c a l he a lth a utho ritie s if suc h re so urc e s a re a va ila b le . Co nta c t the CDC a t 800-CDC-INF O (800-232-4636) o r the Na tio na l L e a d Info rma tio n Ce nte r a t 800-424-L E AD (5323) fo r re so urc e s.

–

T a ke a c a r e ful e nvir

  • nme nta l histor
  • y. T

a ke c a re to c o nsid e r o the r c hild re n who ma y b e e xpo se d .

–

Pr

  • vide nutr

itiona l c ounse ling r e la te d to c a lc ium a nd ir

  • n.

–

E nsur e ir

  • n suffic ie nc y with a de qua te la bor

a tor y te sting (CBC, F e r r itin, CRP) a nd tr e a tme nt pe r AAP g uide line s. Co nsid e r sta rting a multivita min with iro n.

–

Pe r for m str uc tur e d de ve lopme nta l sc r e e ning e va lua tions a t c hild he a lth ma inte na nc e visits, a s le a d ’ s e ffe c t o n d e ve lo pme nt ma y ma nife st o ve r ye a rs.

PE HSUs’ Re c o mme nda tio ns fo r Ope ra tio na lizing the Ne w CDC Re c o mme nda tio ns

slide-21
SLIDE 21

21

T HE MID- AT L ANT IC CE NT E R F OR CHIL DRE N’S HE AL T H & T HE E NVIRONME NT (MACCHE )

A PE DI AT RI C E NVI RONME NT AL HE AL T H SPE CI AL T Y UNI T (PE HSU)

slide-22
SLIDE 22

22

  • Re g io n 3
  • Pe nnsylva nia , De la wa re , Ma ryla nd, Virg inia ,

We st Virg inia , & the Distric t o f Co lumb ia

  • 1- 866- 622- 2431
  • 202- 476- 4829
  • ma c c he @c hildre nsna tiona l.org
  • www.c hildre nsnational.org/ MACCHE

MACCHE