Combined exchange transfusion and chelation therapy for neonatal lead poisoning.
OBJECTIVE
To describe the results of combined exchange transfusion and chelation therapy in a neonate with an elevated blood lead level (BLL).


METHODS
A 34-year-old Latina woman with a long history of pica (eating glazed pottery) gave birth to a healthy-appearing girl at 40 weeks of gestation. The mother's preconception BLL was 117 microg/dL and remained elevated throughout pregnancy. At parturition, the mother's BLL was 87 microg/dL and the infant's cord BLL was 100 microg/dL. The infant underwent single-volume exchange transfusion within 12 hours of birth. BLL was 28 microg/dL following the exchange, and a 5-day course of chelation with dimercaprol and CaNa2 ethylenediamine tetraacetic acid was initiated at 36 hours of life. The infant's BLL was 37 microg/dL at the end of inpatient chelation.


CONCLUSIONS
Long-term neurologic disability from in utero lead exposure is well described, but the optimal treatment of elevated neonatal BLLs in healthy-appearing infants at the time of birth is not established. This strategy of combined chelation and exchange transfusion therapy was well tolerated and resulted in decreased lead levels, but the long-term neurologic efficacy of our combination strategy remains to be seen.


CONCLUSIONS
Combined exchange transfusion and chelation therapy resulted in rapidly decreased lead levels in a neonate with chronic in utero lead exposure.
Mycyk
Mark B
MB
Division of Emergency Medicine, Northwestern University School of Medicine, Section of Toxicology, Cook County Hospital, Chicago, IL 60611-2930, USA. mmycyk@northwestern.edu
Leikin
Jerrold B
JB
D000328:Adult; D002516:Ceramics / Q000633:toxicity; D002614:Chelating Agents / Q000627:therapeutic use; D015913:Chelation Therapy; D003131:Combined Modality Therapy / Q000379:methods; D004112:Dimercaprol / Q000627:therapeutic use; D004492:Edetic Acid / Q000627:therapeutic use; D005078:Exchange Transfusion, Whole Blood; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007855:Lead Poisoning / Q000188:drug therapy* / Q000209:etiology; D010842:Pica / Q000150:complications; D011247:Pregnancy; D011248:Pregnancy Complications
D002614:Chelating Agents; D004112:Dimercaprol; D004492:Edetic Acid