The CDC blood lead reference value for children: time for a change

The purpose of this article is to consider alternate uses of the blood lead reference value for children. There are two possible approaches. Historically the reference value has been used to guide clinical and public interventions for individual children. As the distribution of blood lead levels in...

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Published inEnvironmental health Vol. 18; no. 1; p. 16
Main Authors Paulson, Jerome A, Brown, Mary Jean
Format Journal Article
LanguageEnglish
Published England BioMed Central Ltd 28.02.2019
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Abstract The purpose of this article is to consider alternate uses of the blood lead reference value for children. There are two possible approaches. Historically the reference value has been used to guide clinical and public interventions for individual children. As the distribution of blood lead levels in the population has been lowered over time, the blood lead level at which interventions are recommended has also been reduced. The use of a reference value of 3.5 μg/dL, based on the 98 percentile of blood lead levels for children in 2011-2014 National Health and Nutrition Examination Survey is under review. For several reasons, adopting the new reference value to guide clinical and public health management puts practitioners in an untenable position. First, the changes in the brain caused by lead are significant and persistent. However, these adverse impacts are subtle and although clearly identified at the population level, not predictive for individual children. In addition, the recommended interventions have not been shown to reduce blood lead levels once they are elevated. Finally, clinical laboratory and office-based blood lead testing devices are not required to quantify blood lead levels < 4 μg/dL and in many cases cannot reliably test for low blood lead levels. Revising the reference value also will undoubtedly result in diversion of resources away from those population-based interventions which have demonstrated success. We argue for second approach, in the management of lead poisoning in the US from one of evaluation and management at the individual level to one of population based primary prevention. This would require a strategy directed at controlling or eliminating lead in children's environment before they are exposed. The reference value, as a benchmark, is essential to ensure that primary prevention efforts are successful.
AbstractList The purpose of this article is to consider alternate uses of the blood lead reference value for children. There are two possible approaches. Historically the reference value has been used to guide clinical and public interventions for individual children. As the distribution of blood lead levels in the population has been lowered over time, the blood lead level at which interventions are recommended has also been reduced. The use of a reference value of 3.5 μg/dL, based on the 98 percentile of blood lead levels for children in 2011–2014 National Health and Nutrition Examination Survey is under review. For several reasons, adopting the new reference value to guide clinical and public health management puts practitioners in an untenable position. First, the changes in the brain caused by lead are significant and persistent. However, these adverse impacts are subtle and although clearly identified at the population level, not predictive for individual children. In addition, the recommended interventions have not been shown to reduce blood lead levels once they are elevated. Finally, clinical laboratory and office-based blood lead testing devices are not required to quantify blood lead levels < 4 μg/dL and in many cases cannot reliably test for low blood lead levels. Revising the reference value also will undoubtedly result in diversion of resources away from those population-based interventions which have demonstrated success. We argue for second approach, in the management of lead poisoning in the US from one of evaluation and management at the individual level to one of population based primary prevention. This would require a strategy directed at controlling or eliminating lead in children’s environment before they are exposed. The reference value, as a benchmark, is essential to ensure that primary prevention efforts are successful.
Abstract The purpose of this article is to consider alternate uses of the blood lead reference value for children. There are two possible approaches. Historically the reference value has been used to guide clinical and public interventions for individual children. As the distribution of blood lead levels in the population has been lowered over time, the blood lead level at which interventions are recommended has also been reduced. The use of a reference value of 3.5 μg/dL, based on the 98 percentile of blood lead levels for children in 2011–2014 National Health and Nutrition Examination Survey is under review. For several reasons, adopting the new reference value to guide clinical and public health management puts practitioners in an untenable position. First, the changes in the brain caused by lead are significant and persistent. However, these adverse impacts are subtle and although clearly identified at the population level, not predictive for individual children. In addition, the recommended interventions have not been shown to reduce blood lead levels once they are elevated. Finally, clinical laboratory and office-based blood lead testing devices are not required to quantify blood lead levels < 4 μg/dL and in many cases cannot reliably test for low blood lead levels. Revising the reference value also will undoubtedly result in diversion of resources away from those population-based interventions which have demonstrated success. We argue for second approach, in the management of lead poisoning in the US from one of evaluation and management at the individual level to one of population based primary prevention. This would require a strategy directed at controlling or eliminating lead in children’s environment before they are exposed. The reference value, as a benchmark, is essential to ensure that primary prevention efforts are successful.
The purpose of this article is to consider alternate uses of the blood lead reference value for children. There are two possible approaches. Historically the reference value has been used to guide clinical and public interventions for individual children. As the distribution of blood lead levels in the population has been lowered over time, the blood lead level at which interventions are recommended has also been reduced. The use of a reference value of 3.5 [mu]g/dL, based on the 98 percentile of blood lead levels for children in 2011-2014 National Health and Nutrition Examination Survey is under review. For several reasons, adopting the new reference value to guide clinical and public health management puts practitioners in an untenable position. First, the changes in the brain caused by lead are significant and persistent. However, these adverse impacts are subtle and although clearly identified at the population level, not predictive for individual children. In addition, the recommended interventions have not been shown to reduce blood lead levels once they are elevated. Finally, clinical laboratory and office-based blood lead testing devices are not required to quantify blood lead levels < 4 [mu]g/dL and in many cases cannot reliably test for low blood lead levels. Revising the reference value also will undoubtedly result in diversion of resources away from those population-based interventions which have demonstrated success. We argue for second approach, in the management of lead poisoning in the US from one of evaluation and management at the individual level to one of population based primary prevention. This would require a strategy directed at controlling or eliminating lead in children's environment before they are exposed. The reference value, as a benchmark, is essential to ensure that primary prevention efforts are successful. Keywords: Blood lead levels, Primary prevention
The purpose of this article is to consider alternate uses of the blood lead reference value for children. There are two possible approaches. Historically the reference value has been used to guide clinical and public interventions for individual children. As the distribution of blood lead levels in the population has been lowered over time, the blood lead level at which interventions are recommended has also been reduced. The use of a reference value of 3.5 μg/dL, based on the 98 percentile of blood lead levels for children in 2011-2014 National Health and Nutrition Examination Survey is under review. For several reasons, adopting the new reference value to guide clinical and public health management puts practitioners in an untenable position. First, the changes in the brain caused by lead are significant and persistent. However, these adverse impacts are subtle and although clearly identified at the population level, not predictive for individual children. In addition, the recommended interventions have not been shown to reduce blood lead levels once they are elevated. Finally, clinical laboratory and office-based blood lead testing devices are not required to quantify blood lead levels &lt; 4 μg/dL and in many cases cannot reliably test for low blood lead levels. Revising the reference value also will undoubtedly result in diversion of resources away from those population-based interventions which have demonstrated success. We argue for second approach, in the management of lead poisoning in the US from one of evaluation and management at the individual level to one of population based primary prevention. This would require a strategy directed at controlling or eliminating lead in children's environment before they are exposed. The reference value, as a benchmark, is essential to ensure that primary prevention efforts are successful.
The purpose of this article is to consider alternate uses of the blood lead reference value for children. There are two possible approaches. Historically the reference value has been used to guide clinical and public interventions for individual children. As the distribution of blood lead levels in the population has been lowered over time, the blood lead level at which interventions are recommended has also been reduced. The use of a reference value of 3.5 [mu]g/dL, based on the 98 percentile of blood lead levels for children in 2011-2014 National Health and Nutrition Examination Survey is under review. For several reasons, adopting the new reference value to guide clinical and public health management puts practitioners in an untenable position. First, the changes in the brain caused by lead are significant and persistent. However, these adverse impacts are subtle and although clearly identified at the population level, not predictive for individual children. In addition, the recommended interventions have not been shown to reduce blood lead levels once they are elevated. Finally, clinical laboratory and office-based blood lead testing devices are not required to quantify blood lead levels < 4 [mu]g/dL and in many cases cannot reliably test for low blood lead levels. Revising the reference value also will undoubtedly result in diversion of resources away from those population-based interventions which have demonstrated success. We argue for second approach, in the management of lead poisoning in the US from one of evaluation and management at the individual level to one of population based primary prevention. This would require a strategy directed at controlling or eliminating lead in children's environment before they are exposed. The reference value, as a benchmark, is essential to ensure that primary prevention efforts are successful.
ArticleNumber 16
Audience Academic
Author Brown, Mary Jean
Paulson, Jerome A
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10.1542/peds.2004-2880
10.1542/peds.2017-0272
10.1016/j.scitotenv.2004.11.021
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Issue 1
Keywords Primary prevention
Blood lead levels
Language English
License Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
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Snippet The purpose of this article is to consider alternate uses of the blood lead reference value for children. There are two possible approaches. Historically the...
Abstract The purpose of this article is to consider alternate uses of the blood lead reference value for children. There are two possible approaches....
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SubjectTerms Analysis
Blood
Blood lead levels
Blood levels
Brain
Child health
Children
Disease control
Disease prevention
Environmental aspects
Environmental health
Health aspects
Lead compounds
Lead content
Lead poisoning
Management
Medical laboratories
Nutrition
Pediatrics
Population
Prevention
Primary prevention
Public health
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Title The CDC blood lead reference value for children: time for a change
URI https://www.ncbi.nlm.nih.gov/pubmed/30819209
https://www.proquest.com/docview/2193647866
https://search.proquest.com/docview/2187526925
https://pubmed.ncbi.nlm.nih.gov/PMC6396537
https://doaj.org/article/88b0370ec5d94ee5b5d76bab26df9ab3
Volume 18
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