A practical clinical approach to diagnosis of fetal alcohol spectrum disorders: Clarification of the 1996 Institute of Medicine Criteria

被引:662
作者
Hoyme, HE
May, PA
Kalberg, WO
Kodituwakku, P
Gossage, JP
Trujillo, PM
Buckley, DG
Miller, JH
Aragon, AS
Khaole, N
Viljoen, DL
Jones, KL
Robinson, LK
机构
[1] Stanford Univ, Sch Med, Dept Pediat, Div Med Genet, Stanford, CA 94305 USA
[2] Univ New Mexico, Ctr Alcoholism Subst Abuse & Addict, Albuquerque, NM 87131 USA
[3] Fdn Alcohol Related Res, Cape Town, South Africa
[4] Univ Witwatersrand, Fac Hlth Sci, Dept Human Genet, Johannesburg, South Africa
[5] Univ Calif San Diego, Sch Med, Dept Pediat, Div Dysmorphol & Teratol, San Diego, CA 92103 USA
[6] SUNY Buffalo, Sch Med, Dept Pediat, Div Genet, Buffalo, NY 14260 USA
关键词
fetal alcohol syndrome; fetal alcohol spectrum disorders; diagnostic criteria; mental retardation; developmental disabilities;
D O I
10.1542/peds.2004-0259
中图分类号
R72 [儿科学];
学科分类号
100202 ;
摘要
Background. The adverse effects of alcohol on the developing human represent a spectrum of structural anomalies and behavioral and neurocognitive disabilities, most accurately termed fetal alcohol spectrum disorders (FASD). The first descriptions in the modern medical literature of a distinctly recognizable pattern of malformations associated with maternal alcohol abuse were reported in 1968 and 1973. Since that time, substantial progress has been made in developing specific criteria for defining and diagnosing this condition. Two sets of diagnostic criteria are now used most widely for evaluation of children with potential diagnoses in the FASD continuum, ie, the 1996 Institute of Medicine (IOM) criteria and the Washington criteria. Although both approaches have improved the clinical delineation of FASD, both suffer from significant drawbacks in their practical application in pediatric practice. Objective. The purpose of this report is to present specific clarifications of the 1996 IOM criteria for the diagnosis of FASD, to facilitate their practical application in clinical pediatric practice. Methods. A large cohort of children who were prenatally exposed to alcohol were identified, through active case-ascertainment methods, in 6 Native American communities in the United States and 1 community in the Western Cape Province of South Africa. The children and their families underwent standardized multidisciplinary evaluations, including a dysmorphology examination, developmental and neuropsychologic testing, and a structured maternal interview, which gathered data about prenatal drinking practices and other demographic and family information. Data for these subjects were analyzed, and revisions and clarifications of the existing IOM FASD diagnostic categories were formulated on the basis of the results. Results. The revised IOM method defined accurately and completely the spectrum of disabilities among the children in our study. On the basis of this experience, we propose specific diagnostic criteria for fetal alcohol syndrome and partial fetal alcohol syndrome. We also define alcohol-related birth defects and alcohol-related neurodevelopmental disorder from a practical standpoint. Conclusions. The 1996 IOM criteria remain the most appropriate diagnostic approach for children prenatally exposed to alcohol. The proposed revisions presented here make these criteria applicable in clinical pediatric practice.
引用
收藏
页码:39 / 47
页数:9
相关论文
共 36 条
[1]  
AASE JM, 1995, PEDIATRICS, V95, P428
[2]  
Aase Jon M, 1994, Alcohol Health Res World, V18, P5
[3]   Was the fetal alcohol syndrome recognized by the Greeks and Romans? [J].
Abel, EL .
ALCOHOL AND ALCOHOLISM, 1999, 34 (06) :868-872
[4]   MATERNAL RISK-FACTORS IN FETAL-ALCOHOL-SYNDROME - PROVOCATIVE AND PERMISSIVE INFLUENCES [J].
ABEL, EL ;
HANNIGAN, JH .
NEUROTOXICOLOGY AND TERATOLOGY, 1995, 17 (04) :445-462
[5]   AN UPDATE ON INCIDENCE OF FAS - FAS IS NOT AN EQUAL-OPPORTUNITY BIRTH-DEFECT [J].
ABEL, EL .
NEUROTOXICOLOGY AND TERATOLOGY, 1995, 17 (04) :437-443
[6]  
Abel EL, 1998, FETAL ALCOHOL ABUSE
[7]  
[Anonymous], 1978, The holy bible: New international version
[8]   Diagnosing the full spectrum of fetal alcohol-exposed individuals: Introducing the 4-Digit Diagnostic Code [J].
Astley, SJ ;
Clarren, SK .
ALCOHOL AND ALCOHOLISM, 2000, 35 (04) :400-410
[9]   Identifying maternal self-reported alcohol use associated with Fetal Alcohol Spectrum Disorders [J].
Barr, HM ;
Streissguth, AP .
ALCOHOLISM-CLINICAL AND EXPERIMENTAL RESEARCH, 2001, 25 (02) :283-287
[10]   Direct and indirect effects of prenatal alcohol damage on executive function [J].
Connor, PD ;
Sampson, PD ;
Bookstein, FL ;
Barr, HM ;
Streissguth, AP .
DEVELOPMENTAL NEUROPSYCHOLOGY, 2000, 18 (03) :331-354