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7217234 
Journal Article 
Abstract 
Treatment of congenital lead poisoning with succimer 
Leydorf, M; Vaidya, A; Luneburg, P; Hines, EQ 
2019 
1 
Clinical Toxicology
ISSN: 1556-3650
EISSN: 1556-9519 
57 
10 
1014-1015 
English 
WOS:000477872100263 
Background: Pediatric lead poisoning is a well-recognized environmental exposure, known to cause detrimental neurodevelopmental effects. However, congenital lead exposure is rare and little understood. Additionally, the safety and efficacy of neonatal chelation is not well established. We present a unique case of intrauterine lead exposure associated with maternal pica and describe the use of oral succimer (dimercaptosuccinic acid, DMSA) in the neonate. Case Report: A 26-year-old G6P0141 woman transitioned care to our institution at 27 weeks pregnancy. She reported cravings for dirt consistent with pica, and lab work demonstrated iron deficiency anemia. This anemia proved to be refractory to adequate iron supplementation. The maternal blood lead level was checked at 35 weeks and found to be 38.7 μg/dl. A female infant was delivered at 37 weeks gestation via scheduled induction due to gestational hypertension. Cord blood lead level at delivery was 54 μg/dl. The infant's exam was normal except for mild, brief respiratory distress; no hepatomegaly was observed, and neurologic exam was normal including newborn reflexes, activity, and tone. Her hemoglobin and hematocrit were normal at 16.2 μg/dl and 45.9%, respectively. A capillary lead level, drawn on day of life 2 and pending at time of discharge, resulted at 57.7 μg/dl on her sixth day of life. The infant was admitted for initiation of chelation therapy. She received high dose DMSA at 350 mg/m2 every 8 hours for the first 5 days, followed by 350 mg/m2 every 12 hours for an additional 14_ d~ys. She was exclusively formula fed to prevent further lead transmIssIon via breast milk. Her renal and hepatic function remained normal. Skeletal survey revealed no lead lines. Repeat capillary lead level on day 5 of chelation was 23.6 μg/dl. The infant was discharged to a leadfree home to complete chelation therapy with close lead clinic follow up. On day 19 of chelation and on follow up day 59, her lead level stabilized to 28 μg/dl. Case Discussion: Data is limited on the use of chelation therapy to treat lead poisoning in pregnant women and neonates. Lead crosses the placenta by simple diffusion; neonatal levels often approximate or exceed maternal levels. Chelation during pregnancy is reserved for severe symptomatic maternal lead poisoning because mobilization of maternal lead stores may increase lead distribution to the developing fetus and elimination of essential minerals by chelation may be teratogenic. Chelation therapy is generally reserved for neonates with blood lead levels >45 μg/dl. Although the newborn exam is typically normal at birth, congenital lead exposure continues to be associated with impaired cognitive development in children. While chelation is effective in lowering blood lead levels in infants and toddlers, studies have unfortunately failed to demonstrate an associated improvement in longterm cognitive function. Conclusions: We describe a case of neonatal lead poisoning treated with DMSA. Despite initial downtrending blood lead levels, the infant's blood lead level stabilized well above the recommended level. Long term follow up will be crucial to ensure the child reaches her full neurocognitive potential. 
North American Congress of Clinical Toxicology 
TN 
September 23–27, 2019