FETAL ALCOHOL SPECTRUM DISORDERS: LITERATURE DATA AND A CLINICAL CASE
Authors: Babintseva A. , Hodovanets Yu. , Kobylianska-Vasilyeva A. , Petrov V. 
Published: April 2021

According to statistical data, from 3 to 10% of women in many countries of the world abuse alcohol during pregnancy which results in the formation of fetal alcohol spectrum disorders (FASDs). The definition includes fetal alcohol syndrome (FAS); Partial Fetal Alcohol Syndrome (PFAS); Alcohol-related Neurodevelopmental Disorders (ARND) Alcohol-related Birth Defects (ARBD).

According to the criteria of the Center for Disease Control and Prevention, (CDCP, USA) the major FASDs features are facial dysmorphology (smoothing of the nasolabial groove, flat upper lip, shortened eyelid openings); growth retardation (ante- or postnatal body weight or body length ≤ 10 percentiles); functional disorders of the nervous system (global cognitive deficiency, minor movement dysfunction, attention deficiency disorder and hyperactivity, sensor disorders, memory deficiency, social adaptation problems); structural disorders of the nervous system (head circumference ≤ 10 percentile (or ≤ 3 percentile for children with body weight ≤ 10 percentile) or clinically significant cerebral abnormalities found by neurovisualization). Combination of the above mentioned signs with maternal alcoholism during pregnancy in anamnesis underlies FASD diagnostics.  

According to the findings of certain researchers the major pathogenic links of FASDs are associated with ethanol toxic effect on the fetal metabolism, that is, activation of oxidative stress processes and decreased intensity of antioxidant protection; reduced expression of genes essential for development; activation of nerve cells apoptosis; delay of the cellular neuron migration and disorders of their proliferation against insufficiently active enzymatic system of the liver participating in ethanol neutralization.

The article presents a clinical case of FASDs in a newborn girl born from ХІ pregnancy; a pregnant woman who was not registered concerning pregnancy, did not undergo screening examinations, smoked and drank regularly. The girl was born after Х physiological labor in 34 weeks of gestation after preterm rupture of the amniotic sac and anhydrous period of 160 hours. Complete antenatal prevention of respiratory distress-syndrome was performed.

The body weight of the girl at birth was 1600 g, the body length – 43 cm. The child’s condition at birth was assessed as compensated by vital functions, and Apgar score was 8/8. According to the assessment of the nervous-muscular and physical maturation by the New Ballard Score the girl was estimated 25 corresponding to 33 weeks of gestation. Assessment of physical development found the body mass value lower than 10 centile, the body length and head circumference – within the range of 10-90 centile. During physical examination dysmorphic signs were determined including smoothed nasolabial groove (5 points), thin flat upper lip, and shortened eyelid openings. The course of postnatal adaptation of the neonate was complicated by neurological symptoms manifested by the signs of inhibition syndrome. After comprehensive medical aid was provided, the girl was discharged from hospital in a satisfactory condition with recommendations about the necessity of including the child into the catamnestic follow-up with careful assessment of its physical and nervous-psychic development.     

Diagnostics of FASDs is a complicated medical diagnostic process which is best ensured by means of a structural interdisciplinary approach of a strong clinical team consisting of specialists of various areas with mutually complementary experience, qualification and skills. An important role of a neonatologist in detection of children with FASDs is hardly overestimated concerning consistent provision of medical first aid and development of a professional diagnostic way, referral to catamnestic follow-up service and further rehabilitation.