The Neurodevelopmental Consequences of Prenatal Alcohol Exposure

Elizabeth Welch-Carre, RN, MSN, NNP


Adv Neonatal Care. 2005;5(4):217-229. 

In This Article

Challenges in and Timing of Diagnosis

Although FAS can be diagnosed at birth, it rarely is for several reasons. First, some of the defining facial features of FAS such as small palpebral fissures, are difficult to detect in the neonate.[20] Second, some pediatricians do not feel competent to make the diagnosis.[12] Third, there is hesitation to assess a newborn for FAS, even when there is known maternal alcohol use, because to do so would label the mother as an alcohol abuser.[12] Finally, there is a lack of documentation in medical records of maternal alcohol use, likely because healthcare providers do not have a full understanding of the spectrum of deficits attributable to PAE.[12] This is extremely problematic because 4 of the 5 diagnostic categories for PAE require documentation of alcohol use.[12,15]

The diagnosis of FAS, PFAS, ARND, or ARBD usually occurs later in infancy or in early childhood.[1,60] It is during this time period that the facial features of FAS are most evident and behaviors typical of PAE begin to manifest.[60] Often the CNS manifestations of PAE lead to an evaluation and ultimately a diagnosis (Fig 1). Infants may be irritable and fail to meet developmental milestones; young children may exhibit hyperactivity, poor fine-motor control, and/or mental retardation; school-age children may have difficulty following directions and poor impulse control, causing alarm in their parents, healthcare providers, and teachers.[1,60]

The Centers For Disease Control and Prevention's framework for fetal alcohol syndrome (FAS) diagnosis and follow-up care. Reprinted with permission.[8,9]


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