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Development of Canadian screening tools for fetal alcohol spectrum disorder.

https://arctichealth.org/en/permalink/ahliterature154841
Source
Can J Clin Pharmacol. 2008;15(2):e344-66
Publication Type
Article
Date
2008
Author
Y Ingrid Goh
Albert E Chudley
Sterling K Clarren
Gideon Koren
Elaine Orrbine
Ted Rosales
Charlotte Rosenbaum
Author Affiliation
The Motherisk Program, Division of Clinical Pharmacology & Toxicology, The Hospital for Sick Children, Toronto, Ontario.
Source
Can J Clin Pharmacol. 2008;15(2):e344-66
Date
2008
Language
English
Publication Type
Article
Keywords
Alcohol Drinking - prevention & control
Alcoholism - diagnosis - prevention & control
Biological Markers
Canada - epidemiology
Child
Child Behavior Disorders - diagnosis
Developmental Disabilities - diagnosis
Diagnosis, Differential
Esters - analysis
Fatty Acids - chemistry
Female
Fetal Alcohol Spectrum Disorders - diagnosis - epidemiology - prevention & control
Humans
Infant, Newborn
Mass Screening - standards
Meconium - chemistry
Practice Guidelines as Topic
Pregnancy
Pregnancy Complications - diagnosis - prevention & control
Prenatal Exposure Delayed Effects - diagnosis
Substance Abuse Detection
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.
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].
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.
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.
PubMed ID
18840921 View in PubMed
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[Influence of multimetallic pollution of environmental objects on changes in the trace element composition of the biological media in children].

https://arctichealth.org/en/permalink/ahliterature178762
Source
Gig Sanit. 2004 Jul-Aug;(4):11-5
Publication Type
Article
Author
N V Zaitseva
T S Ulanova
L V Plakhova
G N Suetina
Source
Gig Sanit. 2004 Jul-Aug;(4):11-5
Language
Russian
Publication Type
Article
Keywords
Adult
Age Factors
Bile - chemistry
Ecology
Environmental pollution
Female
Gastric Juice - chemistry
Hair - chemistry
Humans
Infant, Newborn
Male
Meconium - chemistry
Metals, Heavy - analysis
Milk, human - chemistry
Placenta - chemistry
Placental Circulation
Practice Guidelines as Topic
Pregnancy
Risk factors
Russia
Spectrophotometry, Atomic
Trace Elements - analysis
Urban Population
Urine - chemistry
Abstract
The paper shows guidelines used to develop a procedure for detecting heavy metals in biological fluids (urine, bile, gastric juice, blood, hair, placenta, meconium, breast milk) by atomic absorption spectrophotometry at the level of 10(-1)-10(-3) microg/ml(-1) with the maximum analysis error of 17.9%. It also proposes guidelines for determining (calculating) the regional background levels of metals in the biological media of children (in case of the Perm Region). The guidelines have been used to compare the ecological situation in large industrial towns of the Perm Region in compliance with the standard levels of metals in the biological media. The results of studies of risk groups, such as lying women and neonatal infants, show a number of relationships and regularities that lie in diminishing the barrier function of the placenta in the mother-newborn system in a poor environmental area.
PubMed ID
15318601 View in PubMed
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Intestinal microbial bile acid transformation in healthy infants.

https://arctichealth.org/en/permalink/ahliterature35324
Source
J Pediatr Gastroenterol Nutr. 1995 May;20(4):394-402
Publication Type
Article
Date
May-1995
Author
G. Jönsson
A C Midtvedt
A. Norman
T. Midtvedt
Author Affiliation
Department of Clinical Chemistry, Karolinska Institute, Stockholm, Sweden.
Source
J Pediatr Gastroenterol Nutr. 1995 May;20(4):394-402
Date
May-1995
Language
English
Publication Type
Article
Keywords
Bifidobacterium - isolation & purification - metabolism - physiology
Bile Acids and Salts - analysis - metabolism
Chenodeoxycholic Acid - analysis - metabolism
Child, Preschool
Cholic Acids - analysis - metabolism
Clostridium - isolation & purification - metabolism - physiology
Fatty Acids, Volatile - analysis - metabolism
Feces - chemistry
Female
Glycine - analysis - metabolism
Humans
Hydrolysis
Infant
Intestines - metabolism - microbiology
Lactobacillus - isolation & purification - metabolism - physiology
Male
Mass Fragmentography
Meconium - chemistry
Prospective Studies
Research Support, Non-U.S. Gov't
Sweden
Taurine - analysis - metabolism
Abstract
Following the establishment of functionally active intestinal flora in three healthy Swedish children from birth up to 24 months of age, we investigated the development of different 24-carbon bile acids. The fecal bile acids were group-separated into unconjugated, glycine-conjugated, taurine-conjugated, and sulfated, so that we could follow the changes between the different fractions of conjugates. In meconium, most (55-63%) of the bile acids were conjugated with taurine; only 11-32% were conjugated with glycine. Deconjugation was the first sign of intestinal microbial activity on the bile acids. Already at 1 month of age, most of the bile acids were deconjugated; among the conjugated bile acids, the glycine-conjugated dominated over the taurine-conjugated. An unidentified conjugate of cholic and chenodeoxycholic acids (C, CDC) that separated with the sulfated bile acids was found. The unconjugated bile acids and those that arose from hydrolysis of existing conjugates were separated and identified by gas-liquid chromatography coupled to mass spectrometry (GC-MS). Twenty-nine different bile acids were identified. In meconium, 16 different bile acids were identified. C and CDC were identified in all samples. The bile acid pattern changed during the course of the study. Many of the identified bile acids were only found in one or a few of the analyzed samples, and sometimes only in samples from one child. 6 alpha-hydroxylated bile acids, probably not microbially synthesized, were present at high percentages in the children.(ABSTRACT TRUNCATED AT 250 WORDS)
PubMed ID
7636681 View in PubMed
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Is meconium useful to predict fetal exposure to organochlorines and hydroxylated PCBs?

https://arctichealth.org/en/permalink/ahliterature112472
Source
Environ Sci Process Impacts. 2013 Aug;15(8):1490-500
Publication Type
Article
Date
Aug-2013
Author
Anna Sofía Veyhe
Therese Haugdahl Nøst
Torkjel M Sandanger
Solrunn Hansen
Jon Øyvind Odland
Evert Nieboer
Author Affiliation
Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, Norway. anna.sofia.veyhe@uit.no
Source
Environ Sci Process Impacts. 2013 Aug;15(8):1490-500
Date
Aug-2013
Language
English
Publication Type
Article
Keywords
Adult
Environmental Monitoring - methods
Environmental Pollutants - analysis
Female
Humans
Hydrocarbons, Chlorinated - analysis
Infant, Newborn
Lipids - analysis
Maternal-Fetal Exchange
Meconium - chemistry
Middle Aged
Norway
Pregnancy
Abstract
The objective of this study is to compare meconium and maternal serum as biomarkers of fetal exposure to organochlorines (OCs). A subset of 40 meconium samples and complementary maternal sera from the Northern Norway Mother-and-Child Contaminant Cohort Study (MISA) were selected. Meconium samples were collected at the earliest opportunity (median 9.0 hours postpartum, range 0-61) and maternal serum in the 2nd trimester (median 19.0 gestational weeks, range 13-34) and analysed for OC contaminants selected from the Arctic Monitoring and Assessment Programme's (AMAP) suite of OCs and selected hydroxylated metabolites. Eight compounds with detection frequencies =70% in both media (criterion for inclusion) were included in the statistical analyses. Median concentration ratios for p,p'-DDE, HCB, trans-nonachlor and cis-nonachlor favoured meconium, and PCB 138 and 153 and OH-PCB 146 and 172 were higher in maternal serum. All inter-media correlations were significant (Spearman's rho) for wet-weight concentrations and improved when concentrations in a small subset of 15 meconium and serum samples were both lipid-adjusted; only OH-PCB 146 slightly favoured maternal serum. Multivariable linear regression modelling confirmed that maternal serum was the most consistent predictor of meconium concentrations, with gestational age and time of meconium sampling improving the models. Although more challenging to analyse, the lipid-adjusted OC concentration in meconium is viewed as a sensitive and informative fetal exposure index when taking into account the gestational age and its postpartum sampling time.
PubMed ID
23828374 View in PubMed
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Legal and ethical considerations in meconium testing for fetal exposure to alcohol.

https://arctichealth.org/en/permalink/ahliterature130540
Source
J Popul Ther Clin Pharmacol. 2011;18(3):e471-4
Publication Type
Article
Date
2011
Author
Bernard M Dickens
Author Affiliation
Faculty of Law and Joint Centre for Bioethics, University of Toronto, Toronto. bernard.dickens@utoronto.ca
Source
J Popul Ther Clin Pharmacol. 2011;18(3):e471-4
Date
2011
Language
English
Publication Type
Article
Keywords
Canada
Decision Making
Ethics, Medical
Female
Fetal Alcohol Spectrum Disorders - diagnosis
Humans
Infant, Newborn
Informed Consent - ethics - legislation & jurisprudence
Meconium - chemistry
Pregnancy
Stereotyping
Abstract
In Canadian law, pregnant women are held to owe no enforceable duties of care to their children before birth, but healthcare providers may be held accountable once children are born alive for causing injuries prenatally. When children are born in hospitals, recovered meconium may be tested without consent, but there may be an ethical duty to inform mothers. Meconium belongs to the newborns, and mothers may be required to make decisions about its use in their children's best interests. Proposals to test meconium from particular populations raise concern about stigmatization.
Meconium, alcohol, fatty acid ethyl esters, ethics, legal duties, pregnancy, fetal alcohol spectrum disorder.
PubMed ID
21992754 View in PubMed
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Meconium testing for fatty acid ethyl esters: a 2011 status report.

https://arctichealth.org/en/permalink/ahliterature138251
Source
J Popul Ther Clin Pharmacol. 2011;18(3):e500-2
Publication Type
Article
Date
2011
Author
Stuart MacLeod
Gideon Koren
Author Affiliation
Department of Pediatrics, University of British Columbia. smacleod@cw.bc.ca
Source
J Popul Ther Clin Pharmacol. 2011;18(3):e500-2
Date
2011
Language
English
Publication Type
Article
Keywords
Canada
Esters - analysis - chemistry
Fatty Acids - analysis - chemistry
Female
Fetal Alcohol Spectrum Disorders - diagnosis
Humans
Infant, Newborn
Mass Screening - methods
Meconium - chemistry
Pregnancy
Pregnancy, High-Risk
Abstract
The Canadian Association of Pediatric Health Centres, working in partnership with the Public Health Agency of Canada has recently published a toolkit to guide screening for identification of risk of FAS/FASD. One of the tools highlighted is the testing of meconium for fatty acid ethyl esters to identify high risk pregnancies and to support associated prevention programs. This paper describes the conclusions of a workshop held in Prince Edward Island in September 2011 to discuss key issues surrounding the wider deployment of meconium testing for assessment of population risk for FAS/FASD.
PubMed ID
22987672 View in PubMed
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Neonatal screening for prenatal alcohol exposure: assessment of voluntary maternal participation in an open meconium screening program.

https://arctichealth.org/en/permalink/ahliterature125917
Source
Alcohol. 2012 May;46(3):269-76
Publication Type
Article
Date
May-2012
Author
Irene Zelner
Sarit Shor
Hazel Lynn
Henry Roukema
Lisa Lum
Kirsten Eisinga
Gideon Koren
Author Affiliation
Division of Clinical Pharmacology & Toxicology, The Hospital for Sick Children, Toronto, Ontario, Canada.
Source
Alcohol. 2012 May;46(3):269-76
Date
May-2012
Language
English
Publication Type
Article
Keywords
Adult
Alcohol drinking - epidemiology
Biological Markers - analysis
Child Development - physiology
Child, Preschool
Early Medical Intervention
Esters - analysis
Fatty Acids - analysis
Female
Fetal Alcohol Spectrum Disorders - diagnosis
Follow-Up Studies
Humans
Infant
Infant, Newborn
Informed consent
Meconium - chemistry
Neonatal Screening - economics - methods
Ontario - epidemiology
Pilot Projects
Pregnancy
Pregnancy Complications - epidemiology
Volition
Abstract
Meconium fatty acid ethyl esters (FAEEs) are validated biomarkers of fetal alcohol exposure. Meconium FAEE testing can potentially be used as a screen by health-care professionals to identify neonates at-risk for Fetal Alcohol Spectrum Disorder, thereby permitting diagnostic follow-up of these children and early intervention in those who develop disabilities. The purpose of this study was to assess whether women would willingly partake in a screening program of this nature. This was determined by launching a pilot screening program for prenatal alcohol exposure in a high-risk obstetric unit previously shown to have a high prevalence of FAEE-positive meconium via anonymous meconium testing. The program involved voluntary testing of meconium for FAEEs and long-term developmental follow-up of positive cases through an existing public health program. The participation rate in the screening program was significantly lower than when testing was conducted anonymously (78% vs. 95%, respectively; p
PubMed ID
22440689 View in PubMed
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Prevalence of fetal ethanol exposure in a regional population-based sample by meconium analysis of fatty acid ethyl esters.

https://arctichealth.org/en/permalink/ahliterature158104
Source
Ther Drug Monit. 2008 Apr;30(2):239-45
Publication Type
Article
Date
Apr-2008
Author
Joey Gareri
Hazel Lynn
Maureen Handley
Chitra Rao
Gideon Koren
Author Affiliation
Motherisk Program, Hospital for Sick Children, Toronto, Ontario, Canada.
Source
Ther Drug Monit. 2008 Apr;30(2):239-45
Date
Apr-2008
Language
English
Publication Type
Article
Keywords
Biological Markers - analysis
Canada - epidemiology
Esters
Fatty Acids - analysis
Female
Fetal Alcohol Spectrum Disorders - diagnosis - epidemiology
Gas Chromatography-Mass Spectrometry
Humans
Infant, Newborn
Meconium - chemistry
Pregnancy
Prenatal Exposure Delayed Effects
Prevalence
Sensitivity and specificity
Abstract
Challenges in identifying children exposed prenatally to ethanol necessitate the development of a biomarker for neonates at risk for fetal alcohol spectrum disorder. Meconium fatty acid ethyl esters (FAEE), products of nonoxidative ethanol metabolism, have been established as a novel biomarker of fetal ethanol exposure. We present the first application of this biomarker to a population-based sample in Canada. Six-hundred eighty-two meconium specimens were anonymously collected in the region of Grey Bruce, Ontario, Canada. Meconium FAEE were extracted by liquid-liquid and solid-phase extraction and analyzed by gas chromatography with flame-ionization detection confirmed by gas chromatography with mass spectrometry. We measured ethyl palmitate (E16:0), ethyl palmitoleate (E16:1), ethyl stearate (E18:0), ethyl oleate (E18:1), ethyl linoleate (E18:2), ethyl linolenate (E18:3), and ethyl arachidonate (E20:4). Seventeen of 682 meconium samples tested positive for significant prenatal ethanol exposure (>2.0 nmol/g). FAEE analysis detected fivefold more ethanol-exposed pregnancies than standard postpartum questionnaires in this population (2.5% versus 0.5%) (P
PubMed ID
18367988 View in PubMed
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Universal or targeted screening for fetal alcohol exposure: a cost-effectiveness analysis.

https://arctichealth.org/en/permalink/ahliterature156262
Source
J Stud Alcohol Drugs. 2008 Jul;69(4):510-9
Publication Type
Article
Date
Jul-2008
Author
Robert B Hopkins
Jon Paradis
Tozheg Roshankar
James Bowen
Jean-Eric Tarride
Gord Blackhouse
Morgan Lim
Daria O'Reilly
Ron Goeree
Christopher J Longo
Author Affiliation
Program for Assessment of Technology in Health, Department of Clinical Epidemiology & Biostatistics, Faculty of Health Sciences, McMaster University, 25 Main Street West, Suite 2000, Hamilton, Ontario, L8P 2A1, Canada. hopkinr@mcmaster.ca
Source
J Stud Alcohol Drugs. 2008 Jul;69(4):510-9
Date
Jul-2008
Language
English
Publication Type
Article
Keywords
Biological Markers - analysis
Cost-Benefit Analysis
Early Intervention (Education) - economics
Fatty Acids - analysis
Female
Fetal Alcohol Spectrum Disorders - diagnosis - economics - rehabilitation
Humans
Infant, Newborn
Male
Meconium - chemistry
Models, Economic
Neonatal Screening - economics
Ontario
Predictive value of tests
Pregnancy
Quality-Adjusted Life Years
Risk factors
Abstract
In this article, we compared the costs of testing meconium for alcohol exposure in newborns with the lifetime benefits of early detection and intervention.
A decision analytic model was developed to assess the cost-effectiveness of testing meconium for two scenarios: (1) all infants in the Canadian province of Ontario and (2) infants who have an older sibling diagnosed with fetal alcohol spectrum disorder (FASD). The model incorporated the costs of early screening, early intervention, and the lifetime societal benefits of early intervention.
The cost of the meconium test is Can. $150. The lifetime societal cost of the disease is Can. $1.3 million per incident case. The benefit of early intervention is an improvement in literacy, which improves the quality of life parameter by 0.17 and increases adult lifetime earnings by $26,400 per year. The ratio of the incremental cost to the incremental benefits results in an incremental cost-effectiveness ratio for mandating a universal screen of all newborns in Ontario of $65,874 per quality-adjusted life years. When considering targeted screening, there is a cost savings for society and improvements in quality of life.
Depending on society's willingness-to-pay threshold for improving infants' lives in a setting of considerable equity concerns, universal screening and targeted screening of infants who have an older sibling diagnosed with FASD both represent policies that are good value for the money.
PubMed ID
18612566 View in PubMed
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9 records – page 1 of 1.