Fetal Alcohol Syndrome

1. Fetal Alcohol Syndrome Lisa Avery, Sarah Bevans, Brooke Graebeldinger, Emily Stokes, Taylor Wittrock

2. Characterized by growth restriction, behavioral disturbances, craniofacial abnormalities, and brain, cardiac, and spinal defects. Major cause of mental retardation in the United States What is FAS?

3. Growth, mental, and physical changes in a woman’s baby can occur if the mother drinks heavily during pregnancy. Alcohol use during pregnancy is the leading preventable cause of birth defects and developmental disabilities. (Weber, M.K. CDC, 1999) In 1999, 12.8% of women said they had drank alcohol when pregnant. Why is this important?

4. Alcohol is a teratogen - has adverse affects on the fetus. Alcohol passes rapidly through the placenta and depending on when the alcohol is consumed it will directly correlate with how the fetus is affected. If alcohol is consumed when the egg and sperm meet, there is an “all or nothing effect” - either the zygote lives or dies. At day 7 or 8, exposure to alcohol can result in craniofacial development abnormalities. At 4-8 weeks, exposure to alcohol can lead to specific organ defects - the neurological system is most commonly affected because it is the most rapid growing system in the fetus. There is no safe period of gestation for a woman to consume alcohol. Pathophysiology of FAS

5. Risk for alcoholism is greater in children that are born to alcoholic mothers. Mental handicaps and hyperactivity are the most debilitating aspects of FAS. The most common problems that children with FAS have are learning, attention, memory, problem solving, incoordination, impulsiveness, and speech and hearing impairments. Deficits in learning are still present through adolescence and adulthood. Psychological Issues

6. In the US, as well as many other areas of the world, alcohol is a socially acceptable and legal “drug”. It is associated with celebrations, relaxing, and socializing; thus not much thought is given to its consequences, especially during pregnancy. Cultural Issues

7. Health teaching is the most important impact on nursing - need to teach parents to maintain control and regain it when needed, develop routines, using calming techniques, and being able to verbally redirect the child when negative behaviors occur. FAS is a growing problem in this country and it is not readily diagnosed in the neonatal period. Nurses need to be aware of how to assess for and intervene with a woman who is drinking during pregnancy. An accurate prognosis for the child is dependant on the disclosure of all substances used in a woman’s health history. Nurses need to be adept in assessing parent-infant interactions in order to be able to detect faulty parenting skills, attachment, and inappropriate interactions that might put the child at risk. How does FAS impact Neonatal Nursing?

8. Signs/Symptoms • Low birth weight • Small head circumference • Failure to thrive • Developmental delays • Organ dysfunction – heart defects • Facial abnormalities – smaller eye opening, flat cheek bones, underdeveloped groove between nose and upper lip, very thin lips, short upturned nose • Epilepsy • Poor coordination and fine motor skills • Poor socialization skills • Lack of imagination • Learning difficulties – poor memory, inability to understand time and money concepts, poor language comprehension, poor problem-solving,

9. Signs/ Symptoms cont. • Behavioral problems – hyperactivity, inability to concentrate, social withdrawal, stubbornness, impulsiveness, anxiety • Deformities to joints, limbs, and fingers • Vision and hearing problems • Sleep problems Risk Factors • Unknown risk factors – nothing shows how much alcohol the mother has to drink in order to cause risk to the fetus, but the more the mother drinks during pregnancy, the higher the risk of the fetus having FAS

10. Making the Diagnosis • FAS cannot be diagnosed in utero; however, once child is born, he or she will be closely monitored for symptoms in the first weeks, months, possibly years • The doctor will look at growth, facial features, heart defects, vision, hearing, cognitive ability, language development, motor skills, and behavior • A doctor may refer the child with symptoms to a genetic specialist to rule out other disorders with similar symptoms

12. Tests to Diagnose • Blood tests in a woman who appears to be intoxicated • Brain CT or MRI to show brain abnormalities • Pregnancy ultrasounds to show slowed growth of the fetus

13. Fetal MRI Ultrasound at 28 weeks

14. Interventions • Avoid heat loss; monitor for signs of hypothermia • Provide small, frequent feedings • Reduce environmental stimuli • Create a quiet, dimly lit environment • Limit number of visitors to one at a time • Monitor newborn vital signs • Observe for evidence of seizure activity • Observe for evidence of respiratory distress • Position infant on right side-lying position or semi-Fowler’s to avoid aspiration of vomitus or secretions • Assess for dehydration and impaired skin integrity related to diarrhea • Help infant achieve self-regulation • Monitor weight gain • Devise strategies to promote nutritional intake

15. Treatment • No cure for FAS • If mom thinks she is pregnant, abstain from alcohol use • If mom is an alcoholic, she needs to seek help and communicate with doctor throughout pregnancy • Physical and mental defects last entire life • Heart defects may often require surgery • Parents can often benefit from counseling • Help parents interpret baby’s cues • Help parents identify appropriate strategies to manage infant’s irritability and hyperactivity • Help parents get set up with community support • Refer parents to social services and visiting nurse associations

16. Implications for Nursing • Long term complications of infants with FAS – delay in oral feeding development, persistent vomiting until 6-7 months of age, difficult adjusting to solid foods and show little interest in foods – will put strain on healthcare system for frequent visits because of frequent sickness. • Involves an appreciation of the impact on the patient of the social environment, as well as the organic brain damage. • Complex family systems can contribute to the psychopathology in the child – depression and suicidal ideations can be present and need to be taken seriously as they could be a cry for help. • Treatment must be multi-modal – family therapy, special education, cognitive testing, and psychopharmaco-therapy must be used to be successful. • Need to have a readily available referral list for practitioners who do research in dealing with FAS. • Know what screening tests are done to be able to educate family on the future.

17. What’s the bottom line? • As nurses, we need to be able to detect a woman who has problems with alcohol use • We also need to be able to educate any woman of child-bearing age (whether she is thinking about becoming pregnant or not) about the harms of drinking alcohol at any time during, before, and after pregnancy. • Abstinence from alcohol and early education is key!

18. References • Force on Fetal Alcohol Syndrome and Fetal Alcohol Effect. CDC. Retrieved Amlung, S., & Kenner, C. (n.d.). Fetal Alcohol Syndrome. National Center of Continuing Education Home Page. Retrieved January 28, 2010, from http://www.homestudyce.com/onlinecourses/onlinecourses/9012.html • Davidson, M, London, M. L., & Ladewig, P.A.W., (2008). Old’s Maternal-Newborn Nursing & Women’s Health Across the Lifespan. Upper Saddle River: Pearson Prentice Hall. • Fetal Alcohol Syndrome. (n.d.). KidsHealth - the Web's most visited site about children's health. Retrieved February 1, 2010, from http://kidshealth.org/parent/medical/brain/fas.html# • Fetal Alcohol Syndrome. (n.d.). Google Health. Retrieved January 30, 2010, from health.google.com/health/ref/Fetal+alcohol+syndrome#Treatment • Fetal Alcohol Syndrome. (n.d.). Mayo Clinic. Retrieved February 1, 2010, from www.mayoclinic.com/helath/fetal-alcohol-syndrome • Hockenberry, M.J., & Wilson, D. (2007) Nursing Care of Infants and Children, Eighth Edition. St Louis: Mosby, Elsevier. • Nursing Interventions to Prevent Secondary Disabilities in FASD: Implications for Clinical Practice. (n.d.). MedScape. Retrieved January 31, 2010, from www.medscape.com/viewarticle/534041_8 • Streissguth, A. P., Ph.D., & O'Malley, K. D., M.D.. (n.d.). Treatment Today; Article #3. UW Departments Web Server. Retrieved February 3, 2010, from http://depts.washington.edu/fadu/Tr.today.97.html • Weber, M. K., Floyd, R. L., Riley, E. P., & Snider, D. E. (n.d.). National Task January 31, 2010, from www.cdc.govmmwr/preview/mmwrhtml/rr5114a2.htm