title: Association of umbilical cord blood lead with neonatal behavior at varying levels of exposure.
abstract: BACKGROUND
  In the light of the ongoing debate about lowering the cut-off for acceptable blood lead level to <5 microg/dL from the currently recommended level of <10 microg/dL, we considered whether prenatal exposure to varying levels of lead is associated with similar or disparate effects on neonatal behavior.
  
  
  METHODS
  Using Brazelton's Neonatal Behavioral Assessment Scale (NBAS), an epidemiological approach and robust statistical techniques like multivariate linear regression, logistic regression, Poisson regression and structural equations modeling analyses we estimated the simultaneous indirect effects of umbilical cord blood lead (CBL) levels and other neonatal covariates on the NBAS clusters.
  
  
  RESULTS
  We observed that when analyzed in all study subjects, the CBL levels independently and strongly influenced autonomic stability and abnormal reflexes clusters. However, when the analysis was restricted to neonates with CBL <10 microg/dL, CBL levels strongly influenced the range of state, motor and autonomic stability clusters. Abnormal walking reflex was consistently associated with an increased CBL level irrespective of the cut-off for CBL, however, only at the lower cut-offs were the predominantly behavioral effects of CBL discernible.
  
  
  CONCLUSIONS
  Our results further endorse the need to be cognizant of the detrimental effects of blood lead on neonates even at a low-dose prenatal exposure.
authors.affiliation: Clinical Epidemiology Unit, Indira Gandhi Government Medical College, Nagpur, India. archana_patel@vsnl.com
authors.forename: Archana B
authors.initials: AB
authors.lastname: Patel
authors.forename: Manju R
authors.initials: MR
authors.lastname: Mamtani
authors.forename: Tushar P
authors.initials: TP
authors.lastname: Thakre
authors.forename: Hemant
authors.initials: H
authors.lastname: Kulkarni