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Previous Volume 344:1421-1426 May 10, 2001 Number 19 Next

	Full Text PDF Editorial by Rosen, J. F. Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background Thousands of children, especially poor children living in deteriorated urban housing, are exposed to enough lead to produce cognitive impairment. It is not known whether treatment to reduce blood lead levels prevents or reduces such impairment.

Methods We enrolled 780 children with blood lead levels of 20 to 44 µg per deciliter (1.0 to 2.1 µmol per liter) in a randomized, placebo-controlled, double-blind trial of up to three 26-day courses of treatment with succimer, a lead chelator that is administered orally. The children lived in deteriorating inner-city housing and were 12 to 33 months of age at enrollment; 77 percent were black, and 5 percent were Hispanic. Follow-up included tests of cognitive, motor, behavioral, and neuropsychological function over a period of 36 months.

Results During the first six months of the trial, the mean blood lead level in the children given succimer was 4.5 µg per deciliter (0.2 µmol per liter) lower than the mean level in the children given placebo (95 percent confidence interval, 3.7 to 5.3 µg per deciliter [0.2 to 0.3 µmol per liter]). At 36 months of follow-up, the mean IQ score of children given succimer was 1 point lower than that of children given placebo, and the behavior of children given succimer was slightly worse as rated by a parent. However, the children given succimer scored slightly better on the Developmental Neuropsychological Assessment, a battery of tests designed to measure neuropsychological deficits thought to interfere with learning. All these differences were small, and none were statistically significant.

Conclusions Treatment with succimer lowered blood lead levels but did not improve scores on tests of cognition, behavior, or neuropsychological function in children with blood lead levels below 45 µg per deciliter. Since succimer is as effective as any lead chelator currently available, chelation therapy is not indicated for children with these blood lead levels.

Source Information

From the National Institute of Environmental Health Sciences, Research Triangle Park, N.C. (W.J.R., N.B.R.); the Department of Environmental Health, University of Cincinnati, Cincinnati (K.N.D.); the Harvard School of Public Health, Boston (J.H.W., D.W.D., M.S.); the Department of Psychology, Children's Hospital of Philadelphia, Philadelphia (J.R.); the Nutritional Biochemistry Branch, Centers for Disease Control and Prevention, Atlanta (R.L.J.); the Kennedy–Krieger Institute, Baltimore (J.J.C.); and the Environmental and Occupational Health Sciences Institute, University of Medicine and Dentistry of New Jersey, Piscataway (G.G.R.). Presented in part at the National Lead Grantee Conference of the Centers for Disease Control and Prevention, Atlanta, December 11, 2000, and at the Society of Toxicology meeting, San Francisco, March 27, 2001.

Address reprint requests to Dr. Rogan at the Epidemiology Branch, National Institute of Environmental Health Sciences, A3-05, P.O. Box 12233, Research Triangle Park, NC 27709, or at rogan{at}niehs.nih.gov.

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