The effects of lead contamination on fetal brain development - Essay Example

The Effects of Lead Contamination on Fetal Brain Development Abstract Lead contamination is not a phenomenon of the past and lead poisoning in newborns and young children still prevails. Old buildings are filled with outdated plumbing and leaded paint, parents work in lead related occupations and cultural traditions often use lead tainted home remedies. Through education and case management the Maternal Child nurse can use his/her role to prevent and provide early detection and treatment in lead poisoning. Lead poisoning is the most serious chronic environmental illness affecting children in spite of interventions to prevent it and cases of lead poisoning still present at hospitals and clinics in the twenty-first century. The prevention, early detection and treatment of lead poisoning are within the sphere of the Maternal Child nurse. The Latin word for lead is plumbum, the root word being reflected in plumbing as lead once lined water pipes due to its anti-corrodible property (Steingraber, 114). Lead is a heavy metal with many uses such as in varnishes, paint and cotton dyes. Old plumbing can contaminate water and the soil in the area. The most common source of lead poisoning in the United States is from paint. Leaded based paint was banned in 1978 many decades after European countries; however, there are many old buildings in need of renovation that still contain lead pipes and paint. Steingraber notes that the effects of lead on the fetus were first observed by women worked in the white lead factories in 1911. The female workers found that once pregnant the disease, plumbism, seemed to be cured. Plumbism refers to the erosion of the brain capillaries from lead and indeed the women would have felt relief once pregnant as then the lead crosses the placenta into the fetus (Steingraber, 114). Lead poisoning causes long term, serious defects as it disturbs an enzyme process that produces heme, which is essential for cellular metabolism (Marcus, pg 2). Children under three and fetuses are the most susceptible as the brain has not completed the blood-brain barrier. Lead causes hemorrhage and swelling as it destroys the capillaries. It can be inhaled or ingested and once absorbed into the blood stream it moves into soft tissue and then is stored in bones and teeth. Continuous exposure will fix lead to the bone in areas where the most growth is occurring. The half life of lead in the blood is 35 days, it remains in soft tissue for 40 days and is then stored in the bones for 20 or 30 years (Cullen et al, pg 9). The lead levels may not reflect an accurate count of the total lead in the system as lead is released when calcium declines and soldiers with shrapnel wounds may have resurfacing lead return to the bloodstream. Lead exposure can happen in some unusual ways such as having consumed homemade liquor or moonshine or from chewing on an imported toy. 90% of ingested lead is eliminated unabsorbed (Cullen et al pg 10). Children are also more susceptible to lead poisoning as they have less bone density than adults and thus the lead remains stored in soft tissues producing toxic effects (Cullen et al, pg 10). Osteoporosis can also lead to elevated blood levels as the decreased calcium releases the lead back to blood and soft tissue. "The effects of lead poisoning on the brain are manifold and include delayed or reversed development, learning disabilities, seizures, coma and even death (Marcus, pg 2). Adults with lead poisoning suffer from depression, aggression, low sperm counts and underweight babies. The problem is world wide and crosses all economic backgrounds with greater percentages in poor areas. The numbers of lead poisoning cases in children has declined over the decades since lead paint was banned and plumbing codes have been updated, however, it remains a concern for low income families living in older buildings in need of renovation. The pregnant women could absorb lead through the water supply and if remodeling is occurring around the living area she could inhale lead in dust particles. Children from low income households were twice as likely to have high lead blood levels as those in wealthier households. According to the United States Department of Labor there are 900 lead related occupations, which include welding, refinery work and glass making (Marcus pg 5). Not only are the workers at risk, but they may bring home lead dust on their clothing to be inhaled by household members. Toxic levels of lead induce iron deficiency anemia and cause renal malfunction. Children may appear to be dehydrated and incorrectly placed on fluid restrictions or anti-diuretics due to the decrease in specific gravity in urine (Marcus pg 6). In the 1940s doctors began to realize that lead poisoning caused long term effects such as nervous disorders. In the 1960s nervous disorders were linked to lead and in the last forty years learning disabilities, aggression and hyperactivity were discovered to have lead contamination as a cause. "The new thinking is that no safe threshold exists for lead exposure in children or fetuses" (Steingraber, pg 115). Cultural differences can also contribute to lead poisoning in that Hispanic and Asian families rely on traditional home remedies which contain lead (DHS 1999). In cultures where breast or bottle feeding is prolonged children have a higher tendency toward pica and put leaded objects into their mouths. Lead was and is used in the manufacture of many products such as tank liners, piping and other equipment to contain corrosive gases or liquids and is used in petroleum refining and in the production of sulpheric acid. It can be found in batteries, plastic, insecticides, steel and some lotions as an astringent (Cullen et al). The role of the Maternal Child nurse is important as the position encompasses the entire family and the environment. The CDC reported in 2003 that poor children are eight times more likely to be exposed to lead poisoning. A child or fetus absorbs up to four times more lead than an adult. Pregnant women absorb as much as 50% of ingested lead compared to 10% to 15% of men and non pregnant women (Royce & Needleman 1985). Early intervention can prevent long term effects from exposure as treatment using chelators can be administered. Chelators bind to heavy metals and extract them from the body. The Maternal Child nurse should be aware that according to the Department of Health Services in 1999, over one sixth of children exposed to lead obtained it from ethnically associated products like home remedies, cosmetics, food and cookware. A thorough family case study could address many issues associated with lead poisoning. The Beneficence and Nonmaleficence principles demand that nurses work to benefit their patients and take care to do no harm. The first obligation is to the unborn child. In dealing with a pregnant woman who may be using leaded ceramic bowls to eat from should be informed that lead binds to milk protein and passes onto the fetus. The physical and neurological effects of lead on the baby need to be made clear. Education and case management can reduce the incidence of lead poisoning in children. The Maternal Child nurse can monitor the environment and work with parents to find other alternatives to traditional medicines and cosmetics. If the living space is in an old building that still contains lead paint, perhaps arrangements could be made for apartments with young children to be stripped and repainted. If that is not possible then parents can take precautions to ensure that the baby does not chew on window sills or break leaded glass. Maternal Child nurse leaders can work with community resources and landlords to disperse correct information about the dangers of lead and the sources of exposure. A study done in 2005 in Saint Louis did not show a decrease in lead poisoning in spite of education and blood levels being drawn (Dugbatey et al). However, due to the difficulties of conducting the study the results should not rule out the benefits of education and prevention. Researchers theorized that through education and case management there would be a reduction in lead poisoning in newborns of women receiving the services. Recruits for the study were drawn from neighborhood health care centers and in spite of offering money to participate many women dropped out, were not pregnant or did not show up for blood draws. Some feared the home assessment because of possible conflicts with landlords and in other cases a husband or significant other refused to allow the intervention team into the household. Health care must fight big business to protect future generations. In the United States Dutch Boy paints created a charming little character in 1949 for their lead based paints to counteract the bad publicity given white lead paint (Steingraber). A similar cartoon character, Joe Camel, was created for cigarettes to imply that such products are not harmful to children. The Precaution Principle was first introduced in West Germany in the 1970s in environmental law, but became more widely know in the Earth Summit of 1992 when precaution was indicated as an important element in policy making and chemical regulations (Steingraber). At the conference in 1998 it was decided that precautionary measures were necessary as scientific validation of a harmful substance often took too long. The Maternal Child nurse can aid the childbearing family with physical assessments, teaching self care and nutrition, environmental assessments, family teaching and fetal assessment. The guidance offered during the pregnancy and post partum newborn period can serve to prevent unnecessary exposure and absorption of lead. Parents can be made aware of the risks of lead exposure and the importance of early intervention and treatment for the child. While lead products are still being produced, many older buildings have outdated plumbing and ethnic products may contain lead, the Maternal Child nurse can offer services and support to decrease the numbers of poor children with lead poisoning. Monitoring of the home environment, education and case management can ensure that fewer babies are born with impaired brain functions leading to a life time of physical and behavior problems. Reference List Dugbatey, Kwesi, Evans, Gregory R., Narayan, Gopal, Osamuniamen, Osa-Edoh. (2005). Lessons from a Primary-Prevention Program for lead poisoning among inner-city children. Journal of Environmental Health, 68(5)15+ Steingraber, Sandra. (2001)Having faith: An ecologist's journey to motherhood. Cambridge, MA: Perseus Books Department of Health Services (DHS). (1999) Summary of the Science and Advisory Panel. Recommendations on screening. In a grant proposal submitted by the DHS and the Public Health Institute to the Centers for Disease Control and Prevention. March 31. Royce, S. and Needlgeman H. eds. (1985). Case studies in environmental medicine: Lead toxicity. Agency for Toxic Substances and Disease Registry. Centers for Disease Control and Prevention (CDC). (2003). Surveillance for elevated blood lead levels among children-United States, 1997-2001. Morbidity and Mortality Weekly Report 52(ss-10) September 12. Marcus, Steven, MD. (last updated 2005) Lead toxicity. Emedicine.com Retrieved April 25, 2006, from http://www.emedicine.com/emerg/topic293.htm Cullen, Grainne, Dines, Alison, Kolev, Stoyho. (n.d.)Lead. National Poisons Information Service (London Center) Medical Toxology Unit. Intox Database, Retrieved April 25, 2006 from http://www.intox.org/databank/documents/chemical/lead/ukpid25.htm Read More