A neonatologist is called upon to evaluate a newborn with multiple birth defects.
The mother is a 17-year-old runaway who is homeless, had no prenatal care, and continued her habit of getting drunk two to three times a week throughout her pregnancy.
Low birth weight; small head size (microcephaly); facial flattening with epicanthal folds; small eyes (microphthalmos); cardiac murmur (diagnosed as an atrial septal defect); positive Ortolani's sign on left hip and lack of complete hip abduction on that side; chest deformed (pectus excavatum).
CBC: mild anemia. Increased AST and ALT.
CXR: cardiomegaly; pectus excavatum deformity. XR, hip: congenital dislocation of left hip.
No specific treatment available; treat each malformation/dis-ease accordingly
Alcohol is the leading cause of fetal malformations in the
United States. Fetal alcohol syndrome may cause myriad abnormalities, both skeletal and visceral, but usually involves a triad of features: (1) craniofacial dysmorphology, including mild to moderate microcephaly and maxillary hypoplasia; (2) prenatal and postnatal growth retardation; and (3) CNS abnormalities, including mental retardation, with IQs often in the range of 50 to 70. In addition, fetal alcohol exposure leads to an increased incidence of cardiac malformations, including patent ductus arteriosus and septal defects. Risk is dose related.
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