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Published Online, 16 March 2004, www.theannals.com, DOI 10.1345/aph.1D475.
 The Annals of Pharmacotherapy: Vol. 38, No. 5, pp. 821-824. DOI 10.1345/aph.1D475
© 2004 Harvey Whitney Books Company.
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Combined Exchange Transfusion and Chelation Therapy for Neonatal Lead Poisoning

Mark B Mycyk, MD

Assistant Professor of Medicine, Division of Emergency Medicine, Northwestern University School of Medicine; Section of Toxicology, Cook County Hospital; Toxikon Consortium, Chicago, IL

Jerrold B Leikin, MD FACP FACEP FACMT

Professor of Medicine, Evanston Northwestern Healthcare—OMEGA, Evanston, IL; Section of Toxicology, Cook County Hospital; Toxikon Consortium

Reprints: Mark B Mycyk MD, Division of Emergency Medicine, 259 E. Erie, Ste. 100, Chicago, IL 60611-2930, fax 312/926-6274, mmycyk{at}northwestern.edu

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

CASE SUMMARY: 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 µg/dL and remained elevated throughout pregnancy. At parturition, the mother's BLL was 87 µg/dL and the infant's cord BLL was 100 µg/dL. The infant underwent single-volume exchange transfusion within 12 hours of birth. BLL was 28 µg/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 µg/dL at the end of inpatient chelation.

DISCUSSION: 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.

Key Words: chelation, exchange transfusion, lead poisoning, neonate

Published Online, March 16, 2004. www.theannals.com, DOI 10.1345/aph.1D475


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