Initial blood lead testing of neonates

Initial venous blood lead level* (BLL; mcg/dL)	Perform follow-up test(s)^¶
<3.5	According to local lead screening guidelines for children.
3.5-24	Within 1 month (at first newborn visit)^Δ.
25-44	Within 2 weeks. Consultation with a clinician experienced in the management of children with BLLs in this range is strongly advised^◊.
≥45	Within 24 hours and then at frequent intervals depending on clinical interventions and trend in BLLs. Prompt consultation with a clinician experienced in the management of children with BLLs in this range is strongly advised^◊.

The reference level for elevated blood lead in United States children was lowered by the Centers for Disease Control and Prevention to 3.5 mcg/dL (0.17 micromol/L) as of October 2021. Refer to UpToDate content on perinatal lead exposure.

BLL: blood lead level.
* The initial blood lead level may be either from an umbilical cord sample at the time of delivery or an infant venous BLL. A venous blood sample is preferred over a capillary sample. Decisions to initiate or stop breastfeeding or initiate chelation therapy should be based on venous blood lead test results only.
¶ If infants are breastfeeding, also follow recommendations for breastfeeding infants. Refer to UpToDate topics on perinatal lead exposure.
Δ According to pediatric health supervision guidelines (well-baby visit schedule) or as clinically indicated based on trends in blood lead levels.
◊ The higher the BLL on the initial test, the more urgent the need for confirmatory testing.

Adapted from: Ettinger AS, Gurthrie Wengrovitz A (Eds). Guidelines for the identification and management of lead exposure in pregnant and lactating women. National Center for Environmental Health/Agency for Toxic Substances and Disease Registry; Centers for Disease Control and Prevention, Atlanta, GA 2010. Available at http://www.cdc.gov/nceh/lead/publications/LeadandPregnancy2010.pdf. Revised with updated guidance from the Centers for Disease Control and Prevention as of October 2021.

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Initial blood lead testing of neonates