The Neurodevelopmental Consequences of Prenatal Alcohol Exposure

Elizabeth Welch-Carre, RN, MSN, NNP


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

In This Article

The Importance of a Complete History

Thorough prenatal, birth, and postnatal histories are helpful in the diagnosis of FAS, ARND, or ARBD. Foster and adoptive families may not know the child's complete medical history and often need to rely on records from medical professionals, social workers, and adoption agencies. Currently, children who do not have the classic facial features of FAS and do not have documentation of PAE have difficulty receiving an alcohol-related diagnosis. To address this, the University of Washington has developed a more precise 4-digit diagnostic code system. This system, which uses specific criteria to identify individuals with PAE, is used as a screening tool for all children entering the foster care system in Washington state.[62]

Maternal history is an important component in determining if an infant has had PAE. From the history, the examiner can assess maternal risk factors.[28] This assessment is particularly important for the infant who is in the well-baby nursery and shows no signs or symptoms of alcohol exposure. Fetal alcohol syndrome, ARND, and ARBD occur in all racial, cultural, and ethnic groups; however, there are infants who are at higher risk. These risk factors are associated with maternal factors including: • Age >25 years;

  • Documented high blood-alcohol concentration;

  • History of alcohol abuse and/or other substance abuse;

  • History of living with an alcohol abuser;

  • Low socioeconomic class;

  • Low self-esteem;

  • Loss of children to a foster care system;

  • Single status;

  • More than 3 children;

  • A previous child with FAS;

  • Unemployment and social transience[15,17,64]

Anytime a mother has a known history of illegal drug use, alcohol use should be explored, because polydrug use is common.[64]

The infant or child's history is equally important for diagnosis. A history of growth deficits, developmental delays, or CNS abnormalities are suspect for alcohol exposure.[15]

The diagnosis of FAS is based on a clinical examination.[1,15] The philtrum and the vermillion are compared to a University of Washington standard key. Palpebral fissures are measured and compared to standards.[60] The classic facial characteristics of FAS are a manifestation of early exposure; a fetus exposed after the first trimester may not exhibit the typical face of FAS, yet may still have significant neurological damage.[15,20] Head circumference at birth and throughout early childhood is documented as this is one of the simplest means of measuring abnormal brain growth (Fig 2).[1]

The typical facial features of a child with fetal alcohol syndrome. Courtesy of Susan Astley, PhD. Photo © 2005 by The University of Washington.

Other professionals who may be included in the diagnostic process include a geneticist, a medical social worker, a psychologist, a physical therapist, an occupational therapist, and a speech and language therapist. Together these disciplines collect data to determine if the child exhibits the physical, neurodevelopmental, and/or cognitive signs and symptoms associated with FAS or an FASD.[65]


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