Combined Exchange Transfusion and Chelation Therapy for Neonatal Lead Poisoning

Abstract

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.