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Western NY Lead Poisoning Resource Center, Rochester Office
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To: Healthcare providers serving children and pregnant women in Chemung, Livingston, Monroe, Ontario, Schuyler, Seneca, Steuben, Wayne, and Yates counties

Spring 2021
Lead News for Healthcare Providers
Volume 6, Issue 1 
(click here to download pdf version with images/color)   

 Topics in this issue:

Contact us toll-free at 877-352-5775 with specific questions or concerns about lead.  Also remember to check out our Facebook page and share it with your patients to get important updates on the health effects of lead and how to prevent exposure.

 

How many children in your practice missed a blood lead test during the pandemic? 

Covid-19 resulted in decreased blood lead testing of young children across the nation. The CDC reported that 34% fewer US children had BLL testing during January – May 2020 when compared to the same period in 2019, with an estimated 9,603 children with BLL missed (www.cdc.gov/mmwr/volumes/70/wr/mm7005a2.htm).  Our county health departments report local declines in testing as well. 
   
 

You can identify which children missed a test using NYSIIS Test Due List Reports 

When you enter search criteria (test and time frame), NYSIIS Test Due List Reports sort results in chronological order by date of birth. You can use NYSIIS to produce a letter and envelope label to the parent/guardian of a child whose test is due. You can also use NYSIIS Follow Up Reports to list kids with elevated blood lead levels who need venous confirmation or follow-up levels according to NYS guidelines (www.health.ny.gov/publications/2501.pdf). Providers are strongly encouraged to use NYSIIS reports and letters to comply with regulations. Contact jenniferd_becker@urmc.rochester.edu for assistance.

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How do you do Lead Risk Assessment?

NYS requires lead exposure risk assessments for all pregnant patients at the first prenatal visit and for children at every well child visit from 6 months to 6 years. This is important!  Practices can do it using a paper form, on a tablet, via a patient portal, or as part of the template used by the provider for the visit.  Questions can be filled out by the family or asked verbally by a medical assistant, nurse, nurse practitioner or doctor. NYS DOH’s recommended risk assessment questions were updated in Sept 2019 and can be found at https://www.health.ny.gov/publications/6670.pdf.

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Information required by local health departments for all patients with elevated blood lead levels (BLLs) 

Since NYS regulations changed in October 2019, whenever a child has a venous blood lead level > 5 ug/dL local health departments need to collect the following information from the health care provider:

  • Hemoglobin/hematocrit or CBC - if providers automatically have these drawn with all initial or confirmatory venous lead levels that would really help because local health department staff are often having to backtrack and wait 3 months or more for this, or parents refuse, or the PCP may forget to order it again even though the health department requests it. 
  • Recent assessments - if the child has not had these done recently (3-6 months for infants and toddlers; 6-12 months for over 3 year olds) then they need a new one:
    • Physical with complete neuro exam
    • Nutritional assessment including an assessment of iron, calcium, and Vitamin C intake and consideration of checking labs for iron deficiency
    • Developmental assessment using a standardized tool

In addition, remember that follow-up of any BLL > 5 ug/dL (capillary or initial venous test) must be done with a venous test at the appropriate time. See https://www.health.ny.gov/publications/2501.pdf for details or contact us at 585-276-3105 with questions.
 
Complete Guidelines for Health Care Providers for the Prevention, Identification, and Management of Lead Exposure in Children are on the NYS DOH website at https://www.health.ny.gov/publications/6671.pdf.  Copies for your practice (either booklet or laminated wall chart format) can be ordered from: https://www.health.ny.gov/forms/order_forms/lead.pdf

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Lead in baby food has been in the news again, but it is not new! 

The American Academy of Pediatrics' HealthyChildren.org website has updated their guidance page on this topic: www.healthychildren.org/English/ages-stages/baby/feeding-nutrition/Pages/Metals-in-Baby-Food.aspx.

In addition, the NYS Children's Environmental Health Center has a new page about "Heavy Metals in Baby Food and Juice" nyscheck.org/heavy-metals-in-baby-food-and-juice/

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Lead in water

Water is not a major source of lead exposure for most children.  For toddlers with the highest blood lead levels, soil and dust are the biggest sources (more than 70%).  However for infants, water can be a significant contributor.  A common way this happens is when infant formula is mixed using lead contaminated tap-water.  The contamination is most likely to come from the home’s water service line, interior pipes, or plumbing fixtures.  Pregnant women are also at risk.  Did you know that until 2014, brass plumbing fixtures and fittings could have up 8% lead content by weight? How old is the faucet in your house?  If you have older faucets, make sure to run the cold water to flush the lines before drinking.  If you want to replace them, the National Sanitation Foundation (NSF) provides catalogs and a computer web site listing approved "lead free" fixtures. NSF can be reached at 1-800-NSF-MARK or www.nsf.org.

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Coalition News

Check out the Coalition to Prevent Lead Poisoning's YouTube Channel for 18 "webisodes" about various lead related topics www.youtube.com/channel/UCUGQJrw_qT0LIrOdy13BlDQ. Some lead coalition work has been on hiatus as local health department respond to the pandemic.  The Finger Lakes Coalition to STOP Lead Poisoning started bi-monthly meetings again in March 2021.  The Chemung County Lead Coalition’s successful HUD grant application has resulted in the City of Elmira working with property owners to eliminate lead hazards during the pandemic.  See www.cityofelmira.net/?page_id=4811.

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If families know about lead but don't have resources to eliminate lead hazards in their home...what then? 

Larger cities in NYS have grant programs to help families reduce lead in their home, but smaller cities, towns, and rural areas have fewer resources.   Local lead coalitions work at solving these issues for families and may seek grant funding appropriate for their areas.   Let them know about specific needs so they can gather information and make the case for funding.

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The Rochester office of the Western NY Lead Poisoning Resource Center
is supported by the New York State Department of Health.

Copyright © 2021 Western NY Lead Poisoning Resource Center, Rochester Office, All rights reserved.


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