USPSTF: Inconclusive evidence of lead testing in asymptomatic children

The US Prevention Services Working Group (USPSTF) has issued a new recommendation that there is insufficient evidence to badess the benefits and harms of screening for high blood lead levels in children and asymptomatic pregnant women.

The current recommendation is an update of the previous 2006 statement which recommended that routine screening for blood lead levels be not performed in asymptomatic children aged 1 to 5 years at average risk or in asymptomatic pregnant women. These recommendations corresponded to the "recommendation D" level, defined by the USPSTF as a service "offering medium or high certainty that the service has no net benefit or that the disadvantages outweigh the benefits". The current update has been issued as a "Statement I" for insufficient evidence.

In an accompanying editorial, Adam J. Spanier, MD, PhD, MPH, Pat McLaine, DrPH, IA, and Robyn C. Gilden, PhD, IA, emphasized the importance of recognizing this. affirmation not as a recommendation against the prevention service, but as recognition that the evidence is insufficient to recommend for or against the service.

"Statement I should not be construed as sufficient proof that the service is useless. The statement should serve as a rationale for funding agencies to steer resources towards gaps in the screening and intervention literature, "wrote Spanier, McLaine and Gilden.

In a separate editorial in JAMA PediatricsMichael Weitzman, MD, Department of Pediatrics, NYU Langone Health, also called for more rigorous research to be done to answer the remaining questions about screening for and preventing lead exposure.

"The inconclusive findings of the new USPSTF recommendation do not mean that screening for high levels of lead in children is not necessary, nor does it help to know whether screening should target children." at high risk or it's to be done universally, "wrote Weitzman. .

Although no studies directly comparing the health effects of screening versus the lack of screening in young children and during pregnancy have been found, some randomized clinical trials (RCTs) have evaluated interventions for high blood lead levels in children. These have had mixed results or have not found clear effects of nutritional supplementation or lead reduction at home.

Only one RCT showed that calcium supplements were badociated with a reduction in blood lead levels compared with placebo in healthy pregnant women. The USPSTF noted that no studies examining the health effects of asymptomatic pregnant women after lead reduction interventions were found.

The USPSTF has found no studies evaluating the harms of screening for the elevation of blood lead levels in children, but only 2 dealing with the harms of treatments. A good quality study showed that dimercaptosuccinic acid treatment contributed to a slight significant decrease in height growth of children over a 34-month period. A poor quality study of penicillamine chelation therapy reported treatment-related adverse events including leukopenia, thrombocytopenia, hives and maculopapular rash, urinary incontinence, abdominal pain, and diarrhea. They found no studies evaluating the harms of screening or treating hyperglycemia in pregnant women.

Until further research can be conducted to answer the remaining questions, the USPSTF report points to other institutions. These include the American Academy of Family Physicians, which recommends not routinely screen for blood lead levels in asymptomatic children at average risk. The American Academy of Pediatrics highlights federal, regional and local screening testing requirements for children living in high-prevalence areas with identified lead risks, or immigrant, refugee or adopted children. l & # 39; abroad.

For asymptomatic pregnant people, the American Academy of Family Physicians recommends not performing routine screening. The US Centers for Disease Control and Prevention (CDC) and the American College of Obstetricians and Gynecologists recommend targeted screening during pregnancy and screening of pregnant or badfeeding individuals with a risk factor ≥1.

the USPSTF recommendation, proof report, and editorial of Spanier et al were published in JAMA. The Weitzman editorial, "Blood lead screening and the permanent challenge
prevention of children's exposure to lead, "Was published in JAMA Pediatrics.