New lead screening guidelines from the Centers for Disease Control and Prevention: how will they affect pediatricians?

Abstract

In October 1991, the Centers for Disease Control and Prevention (CDC) issued lead screening guidelines1 that 1. Recommended blood lead screening for virtually all 1-year-old children and, when resources permit, for all 2-year-old children as well; 2. Suggested five questions that physicians could use to assess whether an individual child might be at risk for lead poisoning; 3. Offered recommendations regarding further testing and follow-up should a blood lead level (BLL) ≥10 μg/dL be found. In 1993, the American Academy of Pediatrics (AAP) published recommendations2 similar to those of the CDC. Both sets of recommendations were influenced by reports demonstrating adverse neuropsychologic effects from BLLs as low as 10 μg/dL3,4and by data from the second National Health and Nutrition Examination Survey (NHANES II), conducted 1976–1980, showing that 88% of 1- to 5-year-old children had BLLs ≥10 μg/dL.5,6 Subsequent to publication of the 1991 CDC and 1993 AAP guidelines, data from a number of blood lead screening studies demonstrated marked variation in the prevalence of elevated BLLs.7-12Publication of data from these studies, many appearing in the February 1994 issue of this journal, resulted in a commentary in the same issue that questioned the appropriateness of the CDC screening and follow-up recommendations.13 Variation in the prevalence of children with BLLs ≥10 μg/dL ranged from 71% in central Philadelphia9 and 28% in central Rochester8 to 3.6% in Chicago suburbs7 and 0.6% in Alaska Medicaid children.10 In the Chicago area study, 0.1% of children had a BLL ≥20 μg/dL, and in Alaska none had a BLL ≥11 μg/dL. Results of Phase I (1988–1991) of NHANES III, which were unavailable when the 1991 CDC guidelines were developed, showed a marked reduction in the geometric mean (GM) BLL of 1- to 5-year-old children …