Alcohol Related Birth Injury (FAS/FAE)

Fetal Alcohol Syndrome is the leading known cause of mental retardation in North America. Despite widely publicized warnings that drinking during pregnancy harms the unborn child, alcohol use by pregnant women continues at alarming rates. These children may be identified at birth, but more often, require reassessment in early infancy to confirm the diagnosis.

Neonatal diagnosis is not necessarily a hopeless prognosis. With prompt diagnosis and appropriate intervention and the support of the community, the impact of Alcohol Related Birth Injury and neurodevelopmental disabilities can be minimized.

Factors that Affect the Risk and Severity of FAS:

·  timing of the exposure

·  binge drinking

·  polydrug use

·  genetic variations

Effects of Alcohol on the Developing Fetus:

Physical Appearance:
Fetal Alcohol Syndrome is associated with specific facial characteristics:

Researchers have found that the absence of the physical features of FAS does not indicate that serious neurodevelopmental damage has not occurred.

Other Physical Defects:

Neurodevelopmental Effects:

Brain:
The cerebral cortex is the target of alcohol teratogenesis. Research has demonstrated that specific areas of the brain such as the corpus callosum, cerebellar vermis and purkinge cells are targeted in particular.

Auditory:
Children with FAS typically suffer from hearing deficits in varying degrees of severity. They may suffer from chronic ear infections that last into adulthood. The four types of hearing disorders associated with FAS include:

·  develop delayed auditory function

·  sensorineural hearing loss

·  intermittent conductive hearing loss

·  central hearing loss

It is important that FAS children receive periodic hearing tests.

Opthomalogy:
Visual disorders commonly associated with FAS include:

·  strabismus

·  optic nerve hypoplasia

·  posterior haze of the cornea

Dento-Facial:
Children who have facial characteristics of FAS may also suffer from TMJ and Malocclusion.

Immune System:
Researchers are studying the affect of alcohol on the fetal immune system. There appears to be a relationship between alcohol exposure and the reduction of T-cells.

Neurodevelpmental Defects - Primary Disabilities:
FAS neurodevelopmental defects include primary disabilities in:

Neurodevelopmental Defects - Secondary Disabilities:
FAS neurodevelopmental defects include the following secondary disabilities:

The Role of the Health Professional in Prevention of FAS/FAE:

·  Screening
    - The importance of asking the right questions
    - Screening Tools
    - High Risk Patients

·  Patient Education

·  Advocacy

·  Diagnosis

Diagnostic Criteria:
    

·  Fetal Alcohol Syndrome
    - Positive maternal history of alcohol ingestion
    - Prenatal growth deficiency
        - small for gestational age
        - failure to thrive that is unrelated to nutrition
        - low weight to height
    - Specific craniofacial deformities
    - Neurodevelopmental impairments
        - small brain size
        - impaired fine motor skills
        - "clumsy" and "accident prone"
        - impaired hand-eye coordination
        - memory deficits

·  Fetal Alcohol Effects
    - Confirmed prenatal exposure to alcohol
    - Presence of some FAS facial characteristics
    - Growth deficits or
    - Neurodevelopmental deficits or
    - Behavioural/Cognitive abnormalities

Differential Diagnosis:
    - Reactive Disorder (attachment disorder)
    - Attention Deficit Disorder
    - Autism
    - Tourettes Syndrome
    - Oppositional Defiant Disorder
    - Language Disorders
    - Learning Disabilities
    - Sensory Development Disorder
    - Pervasive Development Disorder
    - Mental Health Disorders

Treatment Protocols:
    - Definitive diagnosis essential insuring adequate resource access
    - Assess impact of neurodevelopmental defects (hearing, vision)
    - Monitor high risk environment
    - Parent support & education
    - Medication