Fetal alcohol spectrum disorders (FASD)

• Fetal alcohol syndrome
• Partial fetal alcohol syndrome
• Alcohol related neurological disorder
• Alcohol related birth defects

• 779.4 Drug reactions and intoxications specific to newborn1

• Q86.0 Fetal alcohol syndrome (dysmorphic)2

• Pattern 5B: Impaired neuromotor development3

Description

• Includes range of severity of defects related to excessive maternal consumption of alcohol during pregnancy4
• Characterized by
  • Short stature
  • Microcephaly
  • Developmental delays
  • Atypical facial features
  • Cognitive impairment

Essentials of Diagnosis

• Partial fetal alcohol syndrome
  • Characterized by at least two typical facial characteristics and one other typical syndrome characteristic4
• Alcohol related neurological disorder (ARND)
  • Less severe form4 that does not involve atypical facial features but does involve at least one other typical syndrome characteristic4
• Alcohol related birth defects
  • Includes at least two facial characteristics, at least one major congenital organ defect, and at least two minor defects2

General Considerations

• Prenatal exposure to alcohol is the most common preventable cause of mental retardation
• May also have4
  • Cardiac defects
  • Neural tube defects
  • Genitourinary defects
  • Behavioral problems
    • Stranger anxiety
    • Inappropriate social interactions
    • Poor judgment

Demographics

• 30% to 40% of offspring of mothers whose daily intake of alcohol exceeds 3 ounces4
• 0.5 to 2 per 1,000 live births4

Signs and Symptoms4

• Growth
  • Short stature
  • Developmental delay
  • Failure to thrive
  • Prenatal and postnatal growth deficiency
• Craniofascial
  • Short palpebral fissures
  • Atypical facial features
  • Flat philtrum
  • Thin vermillion of upper lip
• Central nervous system
  • Microcephaly
  • Optic nerve hypoplasia
  • Hypotonic
  • Partial or complete agenesis of the corpus callosum
  • Cognitive impairment
  • Tremors

Functional Implications

• Difficulty with complex cognitive function4
• Short attention span
• Difficulty with short term memory
• Difficulty with balance and coordination

Possible Contributing Causes

• Consumption of more than 3 ounces of alcohol per day during pregnancy4

Imaging

• Computerized tomography (CT scan)
• Magnetic resonance imaging (MRI)
• Maternal ultrasound

Medication

• There are no medications that directly address FASD
• Medications may be used to treat symptoms such as:
  • Stimulants to treat hyperactivity
  • Antidepressants, antianxiety medication, or neuroleptics to address behavioral difficulties5

• Neurologist
• Otolaryngologist
• Gastroenterologist
• Occupational therapist
• Speech therapist

• Frequently fall when walking
• Decreased coordination

• Bayley Scales of Infant Development-II
• Peabody Development Motor Scales-2 (PDMS-2)
• Neonatal Behavioral Assessment Scale
• Bruininks Oseretsky Test of Motor Proficiency

• Early intervention services5
• Behavioral therapy5
• Developmental activities
  • Acquisition of motor milestones through facilitation
• Therapeutic exercise
  • Coordination
  • Balance
  • Strengthening

• Ambulate through an obstacle course without falling within 3 months to increase stability
• Walk forward on a low balance beam ...