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Treatment with the chelating agent disodium versenate has been recommended for children with asymptomatic moderate lead poisoning whose results also are positive in a lead mobilization test. However, controlled studies of the agent that demonstrate its effectiveness in inducing a sustained reduction in blood lead levels or lead-associated toxicity have not been performed in such children. The relationship between calcium disodium versenate chelation and measures of lead burden and toxicity in children with moderate lead poisoning were assessed in this study. Results showed that, when pretreatment levels were considered, the supposed effectiveness of calcium disodium versenate at lowering lead burden and toxicity was no longer observed. This suggests the need for a randomized, controlled trial of chelation therapy in moderately lead-poisoned children.

Lowering blood lead (BPb) levels can improve intellectual function in children with moderate lead poisoning. Among 154 children aged one to seven, BPb levels ranged from 13 to 46 micrograms per deciliter, and the average was 30 micrograms per deciliter. Sixty-one had significant enough lead poisoning to be eligible for treatment with edetate calcium disodium (EDTA), and 60 were treated for iron deficiency. The children's homes were inspected, and efforts to eliminate their exposure to lead-based paint were successful. In the six months after the program was started, the average BPb level dropped significantly and intellectual function increased. Declines in BPb levels were not associated with any changes in intellectual function seven weeks after the program was initiated. However at six months, improvements in intellectual function were significantly associated with declining BPb levels., Objective.--To determine whether chelation therapy or biochemical changes during a lead-lowering intervention was associated with changes in cognitive functioning of moderately lead-poisoned children. It was hypothesized that cognitive performance would improve as blood lead level declined over time. Design.--Short-term intervention study with measures obtained before and after intervention. Setting.--Hospital specialty clinic and university research center. Patients.--A total of 154 previously untreated children referred to clinic with blood lead levels between 1.21 and 2.66 (micro)l/L (25 and 55 (micro)g/dL) at time of enrollment. Ages ranged from 13 to 87 months. Intervention.--Enrolled children were treated with edetate calcium disodium (EDTA) if eligible and/or with orally administered iron supplement if iron deficient. For all children, housing inspections and abatement procedures were performed as necessary. Main Outcome Measures.-Score on Bayley Mental Development Scale or Stanford-Binet Intelligence Scale (4th edition). Results.--There was no effect of edetate calcium disodium treatment per se. In the short term (7 weeks), changes in blood lead levels were not related to changes in cognitive scores. In the long term (6 months), however, changes in performance were significantly related to changes in blood lead level, even after controlling for confounding variables. The standardized score increased 1 point for every decrease of 0.14 (micro)mol/L (3 (micro)g/dL) in blood lead level. Conclusion.--The results suggest an association between decreases in blood lead level and cognitive improvements in moderately lead-poisoned children. (JAMA. 1993;269:1641-1646)

Objective. Lead (Pb) poisoning remains a common disease among children despite successful public health efforts that have reduced its prevalence. Treatment options for children with blood Pb levels (BPbs) Methods. Children aged 1 to 6 years with BPbs 10 to 45 [micro]g/dL were enrolled in a double-blinded, placebo-controlled trial of the effects of Ca supplementation on BPbs. Children received either a Ca-containing liquid or an indistinguishable placebo. Dosage was adjusted biweekly on the basis of responses to a dietary Ca intake questionnaire to reach 1800 mg in the Ca-supplemented group. Samples for BPbs and measures to assess safety were collected before and after 3 months of supplementation and after an additional 3 months of follow-up. Bivariate and multiple regression analyses were performed. Results. A total of 67 of 88 enrolled children with a mean age of 3.6 years completed 3 months of supplementation. There were no statistically significant differences between groups on hematologic and biochemical measures, including serum and urinary Ca, at any time points. The average compliance rate was estimated to be 80% for each group during the 3-month supplementation period. Conclusions. At enrollment, the average daily Ca intake in this group of inner-city children was greater than the recommended daily intake for age. Although BPbs declined during a 3-month period in both groups, Ca supplementation aimed at providing 1800 mg of Ca/d had no effect on the change in BPbs. Ca supplementation should not be routinely prescribed for mild to moderately Pb-poisoned children who are dietarily Ca sufficient. Pediatrics 2004;113:e34-e39. URL: http://www. pediatrics.org/cgi/content/full/113/1/e34; lead, lead poisoning, calcium, calcium supplementation.