Updated Guidelines for Fetal Alcohol Spectrum Disorders

Beth Skwarecki

July 28, 2016

Updated clinical guidelines for diagnosing fetal alcohol spectrum disorders, field-tested in evaluations of 10,000 children in the United States, South Africa, and Europe, provide more detail on learning and behavioral deficits and include a new flowchart and a photographic guide for lip and philtrum morphology. The new recommendations update guidelines previously issued in 2005.

"We feel that these are practical and can be applied in your office," H. Eugene Hoyme, MD, from Sanford Research and the Department of Pediatrics at Sanford School of Medicine at the University of South Dakota, Sioux Falls, and the Center for Applied Genetics and Genomic Medicine and Department of Pediatrics at the University of Arizona, Tucson, told Medscape Medical News. Dr Hoyme and colleagues published the guidelines online July 27 in Pediatrics.

"We recommend these diagnoses being done by a multidisciplinary team: not just physicians but also therapists and psychologists and so on. And so we feel that because we have all of these different inputs of data into the team, you want to cast a broad net right at the beginning in terms of not missing kids," Dr Hoyme said. He considers the new guidelines to be similar to, but more sensitive than, Canadian guidelines developed independently and issued last year.

In addition to evaluating the child, the new guidelines recommend carefully interviewing the child's mother about her alcohol consumption, beginning with more general questions about the child's health and then narrowing the focus to alcohol during and before pregnancy. The definition of alcohol exposure may include at least six drinks per week during at least 2 weeks of pregnancy, or at least three drinks per occasion on two or more occasions.

After assessing maternal alcohol intake, the guidelines recommend evaluating facial features. A positive result includes two of the following three criteria: short palpebral fissures, smooth philtrum, and thin vermilion border of the upper lip. If either this test or maternal alcohol intake are positive, the guidelines' flowchart recommends a neuropsychology evaluation.

The new guidelines are "much more specific" than the previous ones about what kinds of neurological and behavioral involvement to look for, in each of the disorders on the spectrum, and what tests to use, Dr Hoyme said. For example, fetal alcohol syndrome requires global impairment or at least one neurobehavioral domain 1.5 standard deviations below the mean. The guidelines also include a time line of the emergence of different developmental deficits, giving information on what to look for in infants, toddlers, and school-age children.

The authors have disclosed no relevant financial relationships.

Pediatrics. Published online July 27, 2016. Abstract

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