DEVELOPMENT OF CANADIAN SCREENING TOOLS FOR FETAL ALCOHOL SPECTRUM DISORDER

Main Article Content

Y Ingrid Goh
Albert E Chudley
Sterling K Clarren
Gideon Koren Koren
Elaine Orrbine
Ted Rosales
Charlotte Rosenbaum

Keywords

Fetal alcohol spectrum disorder, screening

Abstract

Fetal alcohol  spectrum  disorder  (FASD)  is the most common  cause of neurobehavioural  handicap  in North America. Screening for FASD may facilitate diagnosis and hence management of these children. We present a variety of screening tools for the identification of children at risk for FASD.


 Methods


We critically reviewed and evaluated published and practiced methods for their potential of screening suspected  cases,  their  epidemiological  characteristics  (sensitivity,  specificity,  positive  and  negative predictive values) [Phase I], as well as their feasibility [Phase II].


 Results


The following five tools were selected for the FASD screening toolkit: screening fatty acid ethyl esters in neonatal  meconium,  the  modified  Child  Behaviour  Checklist,  Medicine  Wheel  tool,  Asante  Centre Probation Officer Tool, and maternal history of drinking and drug use.


 Conclusions


The toolkit for FASD screening aims at screening different populations, from the newborns to youth and at-risk mothers. It is anticipated that the toolkit will facilitate diagnosis of FASD.

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References

1. Chudley AE, Conry J, Cook JL, Loock C, Rosales T, LeBlanc N. Fetal Alcohol Spectrum e365 Disorder: Canadian Guidelines for Diagnosis. CMAJ 2005;172:S1-S21.
2. UK National Screening Committee. What is Screening? http://www.nsc.nhs.uk/whatscreening/whatscree n_ind.htm (March 3, 2008).
3. Wilson, JMG and Jungner, G. Principles and practice of screening for disease. Geneva: WHO (1968).http://www.who.int/bulletin/volumes/86/ 4/07-050112BP.pdf (January 1, 2008).
4. Chavez GF, Cordero JF, Becerra JE. Leading Major Congenital Malformations Among Minority Groups in the United States, 19811986. MMWR CDC Surveill Summ 1988;37:1724.
5. Stade B, Ungar WJ, Stevens B, Beyen J, Koren G. Cost of Fetal Alcohol Spectrum Disorder in Canada. Can Fam Physician 2007;53:13031304.
6. Sokol RJ, Clarren SK. Guidelines for Use of Terminology Describing the Impact of Prenatal Alcohol on the Offspring. Alcohol Clin Exp Res 1989;13:597-598.
7. Sampson PD, Bookstein FL, Barr HM, Streissguth AP. Prenatal Alcohol Exposure, Birthweight, and Measures of Child Size From Birth to Age 14 Years. Am J Public Health 1994;84:1421-1428.
8. Sampson PD, Streissguth AP, Bookstein FL, et al. Incidence of Fetal Alcohol Syndrome and Prevalence of Alcohol-Related Neurodevelopmental Disorder. Teratology 1997;56:317-326.
9. Hanley WB, Demshar H, Preston MA, et al. Newborn Phenylketonuria (PKU) Guthrie (BIA) Screening and Early Hospital Discharge. Early Hum Dev 1997;47:87-96.
10. Walfish PG, Ginsberg J, Rosenberg RA, Howard NJ. Results of a Regional Cord Blood Screening Programme for Detecting Neonatal Hypothyroidism. Arch Dis Child 1979;54:171- 177.
11. Dorval V, Ritchie K, Gruslin A. Screening HIV in Pregnancy: a Survey of Prenatal Care Patients. Can J Public Health 2007;98:379-382.
12. Sussman R, Koren G. Attenuating the Effect of Prenatal Alcohol Exposure With Postnatal Interventions: Critical Review of Animal Studies and Applications to Clinical Research. J FAS Int 2006;4:e13.
13. Kvigne VL, Leonardson GR, Borzelleca J, Brock E, Neff-Smith M, Welty TK. Alcohol Use, Injuries, and Prenatal Visits During Three Successive Pregnancies Among American Indian Women on the Northern Plains Who Have Children With Fetal Alcohol Syndrome or Incomplete Fetal Alcohol Syndrome. Matern Child Health J 2008.
14. Streissguth AP, Sampson PD, Olson HC, et al. Maternal Drinking During Pregnancy: Attention and Short -Term Memory in 14-Year-Old Offspring--a Longitudinal Prospective Study. Alcohol Clin Exp Res 1994;18:202-218.
15. Ingersoll K, Floyd L, Sobell M, Velasquez MM. Reducing the Risk of Alcohol -Exposed Pregnancies: a Study of a Motivational Intervention in Community Settings. Pediatrics 2003;111:1131-1135.
16. Moore ES, Ward RE, Wetherill LF, et al. Unique Facial Features Distinguish Fetal Alcohol Syndrome Patients and Controls in Diverse Ethnic Populations. Alcohol Clin Exp Res 2007;31:1707-1713.
17. May PA, Gossage JP, Marais AS, et al. Maternal Risk Factors for Fetal Alcohol Syndrome and Partial Fetal Alcohol Syndrome in South Africa: a Third Study. Alcohol Clin Exp Res 2008;32:738-753.
18. Centres for Disease Control and Prevention (CDC). Alcohol Consumption Among Women Who Are Pregnant or Who Might Become Pregnant--United States, 2002. MMWR Morb Mortal Wkly Rep 2004;53:1178-1181.
19. Streissguth AP, Bookstein FL, Barr HM, Press S, Sampson PD. A Fetal Alcohol Behavior Scale. Alcohol Clin Exp Res 1998;22:325-333.
20. Roebuck TM, Mattson SN, Riley EP. Behavioral and Psychosocial Profiles of Alcohol-Exposed Children. Alcohol Clin Exp Res 1999;23:10701076.
21. Nash K, Rovet J, Greenbaum R, Fantus E, Nulman I, Koren G. Identifying the Behavioural Phenotype in Fetal Alcohol Spectrum Disorder: Sensitivity, Specificity and Screening Potential. Arch Womens Ment Health 2006;9:181-186.
22. Astley SJ, Stachowiak J, Clarren SK, Clausen C. Application of the Fetal Alcohol Syndrome Facial Photographic Screening Tool in a Foster Care Population. J Pediatr 2002;141:712-717.
23. Astley SJ, Clarren SK. Diagnosing the Full Spectrum of Fetal Alcohol-Exposed Individuals: Introducing the 4-Digit Diagnostic Code. Alcohol Alcohol 2000;35:400-410.
24. Bearer CF, Lee S, Salvator AE, et al. Ethyl Linoleate in Meconium: a Biomarker for Prenatal Ethanol Exposure. Alcohol Clin Exp Res 1999;23:487-493.
25. Moore CM, Lewis D. Fatty Acid Ethyl Esters in Meconium: Biomarkers for the Detection of Alcohol Exposure in Neonates. Clin Chim Acta 2001;312:235-237.
26. Chan D, Bar-Oz B, Pellerin B, et al. Population Baseline of Meconium Fatty Acid Ethyl Esters Among Infants of Nondrinking Women in Jerusalem and Toronto. Ther Drug Monit 2003;25:271-278.
27. Bearer CF, Jacobson JL, Jacobson SW, et al. Validation of a New Biomarker of Fetal Exposure to Alcohol. J Pediatr 2003;143:463469.
28. Chan D, Klein J, Koren G. Validation of Meconium Fatty Acid Ethyl Esters As Biomarkers for Prenatal Alcohol Exposure. J Pediatr 2004;144:692.
29. Peterson J, Kirchner HL, Xue W, Minnes S, Singer LT, Bearer CF. Fatty Acid Ethyl Esters in Meconium Are Associated With Poorer Neurodevelopmental Outcomes to Two Years of Age. J Pediatr 2008;152:788-792.
30. Hutson JR, Magri R, Suarez H, Miguez H, Koren G. Fatty Acid Ethyl Esters and Cotinine in Meconium Are Predictors of Birth Weight in a Uruguay Cohort. Can J Clin Pharm 2007;14:e169.
31. Brien JF, Chan D, Green CR, et al. Chronic Prenatal Ethanol Exposure and Increased Concentration of Fatty Acid Ethyl Esters in Meconium of Term Fetal Guinea Pig. Ther Drug Monit 2006;28:345-350.
32. Hopkins RB, Paradis J, Roshankar T, et al. Universal or Targeted Screening for Fetal Alcohol Exposure: a Cost-Effectiveness Analysis. J Stud Alcohol Drugs 2008;69:510519. 33. Conry J, Fast DK. Fetal alcohol syndrome and the criminal justice system. Vancouver: Fetal Alcohol Syndrome Resource Society, 2000.