LAUSR

A male infant is born at 38 6/7 weeks’ gestation via vaginal delivery to a 23-year-old gravida 3, para 2-0-0-2 woman. On the first day after birth, he is found to have a critically elevated blood lead level (BLL). The infant was tested because of the mother’s prenatal history of an elevated BLL. History revealed the mother had ingested soil from her backyard and used ethnic products from a local store (not tested for lead) throughout the pregnancy. The backyard soil was later tested by the New York City Department of Health and Mental Hygiene (NYC DOHMH), which revealed high lead levels. Five months before delivery, the maternal BLL was 10 μg/dL (0.48 μmol/L). Repeat maternal BLL on postpartum day 2 was 49 μg/dL (2.3 μmol/L). At birth, the newborn Apgar scores were 9 and 9 at 1 and 5 minutes, respectively, the birthweight was 3.57 kg, and the length was 50 cm (body surface area of 0.21 m2). The infant’s venous BLL on the first and second day after birth was 78 μg/dL (3.8 μmol/L). On admission, the infant had unremarkable routine chemistry studies, a hemoglobin of 17 g/dL (170 g/L), and mean corpuscular volume of 90 um3 (90 fL). On the third day after birth, the newborn was transferred from the NICU of an affiliate hospital to our institution for dual chelation therapy with calcium disodium versenate (CaNa2EDTA) and succimer, as recommended by the Centers for Disease Control and Prevention (CDC) and NYC DOHMH guidelines. Succimer is a chelating agent that has 2 sulfhydryl groups capable of complexing to lead, making it water soluble, and thus increasing the urinary excretion of lead. CaNa2EDTA is another chelating agent that chelates lead that has taken the place of calcium and promotes its urinary excretion. …