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.
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.
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)
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.
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.
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.
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
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
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. email@example.com
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.