P3.F104: Demographics and outcomes of children admitted at a tertiary care center with severe lead poisoning.

Background: Lead poisoning is an environmental hazard which can seriously harm a child's health, including adverse effects on the brain and nervous system. Although lead poisoning rates have decreased dramatically over the recent decades, certain geographic “hot spots” remain. In Cleveland, Ohio, 12-13% of children tested still have elevated lead levels, with some neighborhoods seeing rates as high as 25%. The number of children who have lead levels of 45 mcg/dL or higher requiring hospitalization for lead chelation therapy also remains much higher in Cleveland compared to the rest of the country. With lead poisoning being less common now, there are no recent studies of this vulnerable population. Our study aimed to look at the demographic characteristics and follow-up details for all children admitted for lead chelation therapy in the last 10 years at an urban inner city Cleveland tertiary care center.

Methods: This retrospective cross-sectional study was conducted at a tertiary center after approval from IRB. All children under the age of 18 years who required chelation therapy for lead poisoning from Jan 1, 2014 to December 31, 2023 (n=42) were included in the study. Demographic data was collected. Clinical characteristics analyzed from the HER records included: duration of hospitalization, iron status, mean duration of follow, number of readmissions, documented neurobehavioral problems, and the lowest follow-up lead level achieved status post hospitalization.

Results: Children admitted at an inner-city urban hospital in Cleveland had an average age of 3.2 years with a range of 1-7 years. 60% of the admitted children were males. 90% of the hospitalized children had Medicaid as insurance. Average lead level on admission was 56.6 microgram/dl with a minimum of 45 microgram/dl and maximum lead level of 125 microgram/dl. Additionally abnormal ferritin was found in 32% of these children. The average hospital length of stay was 5.5 days. Rehospitalization was required in 31% of these children who were treated with chelation therapy during hospitalization. Racial disparity was present in these children with 57% of the children being African American (figure 1). Chelation therapy was successful in all hospitalized children with maintenance of lead level below chelation level in all children on subsequent blood draw. (Figure 2) However, less than 20% of the children tested subsequently had lead levels less than toxic levels of 5 microgram/dl and only 14% less than 3.5 microgram/dl.

Conclusion: Lead poisoning is a significant public health concern in children in Cuyahoga County with paucity of data around severe lead poisoning requiring hospitalization for chelation therapy. Racial disparity exists among the hospitalized children. Comprehensive prevention and screening programs along with prompt intervention is needed to mitigate lead toxicity in vulnerable populations.