Hospitalizations of children who have fetal alcohol syndrome or incomplete fetal alcohol syndrome.

INTRODUCTION: The study describes the hospitalization rates and medical diagnoses of children with fetal alcohol syndrome (FAS) and incomplete FAS. METHODS: Two retrospective case-control studies were conducted of Northern Plains American Indian children with FAS or incomplete FAS identified from 1981-93 by using the ICD-9-CM code 760.71. Children who had FAS or incomplete FAS were compared to each other and to children who did not have FAS. RESULTS: Compared to the controls, the 43 children with FAS (Study 1) and 35 children with incomplete FAS (Study 2) were hospitalized more often with otitis media (51.2 percent OR=4.32 and 31.4 percent OR=3.02 respectively), pneumonia (46.5 percent OR=4.21 and 34.3 percent OR=2.54), fetal alcohol syndrome (32.6 percent p=.001 and 14.3 percent p=.007), dehydration (23.3 percent OR=9.29 and 17.1 percent OR=4), and anemia (11.6 percent OR=10 and 17.1 percent p=.002) respectively. Children with FAS were hospitalized more often with failure to thrive (32.6 percent p=.001) and neglect (23.3 percent OR=10.0) than children with incomplete FAS and controls. Children with FAS were hospitalized with child sexual abuse (11.6 percent OR=10.0) and feeding problems (11.6 percent p=.007), and children with incomplete FAS were hospitalized with gastroenteritis (22.9 percent OR=14.55) and bronchitis (22.9 percent OR=3.0) more than control children. CONCLUSIONS: Children with FAS or incomplete FAS had more hospitalizations and longer average length of stays than control children.

Characteristics of children whose siblings have fetal alcohol syndrome or incomplete fetal alcohol syndrome.

OBJECTIVE: To describe the clinical features of American Indian children born just before and just after a sibling with fetal alcohol syndrome or incomplete fetal alcohol syndrome. METHODS: Two retrospective case-control studies were conducted of Northern Plains American Indian children with fetal alcohol syndrome or incomplete fetal alcohol syndrome identified from 1981 to 1993 by using International Classification of Diseases, Ninth Revision, Clinical Modification code 760.71. RESULTS: Compared with the controls, the 39 siblings born just before children with fetal alcohol syndrome (study 1) and 30 siblings born just before children with incomplete fetal alcohol syndrome (study 2) had more facial dysmorphology (23.1% and 16.7%, respectively), growth delay (38.5% and 10.0%), and central nervous system impairment (48.7% and 33.3%). The 20 siblings born just after children with fetal alcohol syndrome (study 1) and 22 siblings born just after children with incomplete fetal alcohol syndrome (study 2) had more facial dysmorphology (20.0% and 9.1%, respectively), growth delay (45.0% and 22.7%), and central nervous system impairment (50.0% and 31.8%) than the control siblings. CONCLUSIONS: The "before" siblings had characteristics of fetal alcohol syndrome that could have predicted that the next child was at risk for fetal alcohol syndrome. The "after" siblings had better outcomes than the previous siblings with fetal alcohol syndrome, a finding that was associated with a decrease in maternal alcohol consumption during the after-sibling pregnancy.

Alcohol use, injuries, and prenatal visits during three successive pregnancies among American Indian women on the Northern Plains who have children with fetal alcohol syndrome or incomplete fetal alcohol syndrome.

INTRODUCTION: The purpose of the study was to compare three sequential pregnancies of American Indian women who have children with FAS or children with incomplete FAS with women who did not have children with FAS. METHODS: Two retrospective case-control studies were conducted of Northern Plains American Indian children with fetal alcohol syndrome (FAS) (Study 1) or incomplete FAS (Study 2) in 1981-1993. Three successive pregnancies ending in live births of 43 case mothers who had children with FAS, and 35 case mothers who had children with incomplete FAS were compared to the pregnancies of 86 and 70 control mothers who did not have children with FAS, respectively, in the two studies. Prenatal records were abstracted for the index child (child with FAS or incomplete FAS) and siblings born just before and just after the index child, and comparable prenatal records for the controls. RESULTS: Compared to the controls, significantly more case mothers used alcohol before and after all three pregnancies and during pregnancy with the before sibling and the index child. Mothers who had children with FAS reduced their alcohol use during the pregnancy following the birth of the index child. All Study 1 case mothers (100%) and 60% of Study 2 case mothers used alcohol during the pregnancy with the index child compared to 20 and 9% of respective control mothers. More study 1 case mothers experienced unintentional injuries (OR 9.50) and intentional injuries during the index pregnancy (OR 9.33) than the control mothers. Most case mothers began prenatal care in the second trimester. CONCLUSIONS: Alcohol use was documented before, during and after each of the three pregnancies. Women of child-bearing age should be screened for alcohol use whenever they present for medical services. Mothers who had a child with FAS decreased their alcohol consumption with the next pregnancy, a finding that supports the importance of prenatal screening throughout pregnancy. Women who receive medical care for injuries should be screened for alcohol use and referred for appropriate treatment. Protective custody, case management and treatment services need to be readily available for women who use alcohol.

Characteristics of children who have full or incomplete fetal alcohol syndrome.

OBJECTIVE: To describe the clinical features and hospitalization rates of American Indian children with full or incomplete fetal alcohol syndrome (FAS). STUDY DESIGN: Two retrospective case-control studies were conducted of Northern Plains American Indian children with presumed FAS identified from 1981 to 1993 by using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM), code 760.71. Children who had full or incomplete FAS were compared with each other and with children who did not have FAS. RESULTS: Compared with the control children, the 43 children with FAS and the 35 children with incomplete FAS had more facial dysmorphology, growth deficiency, central nervous system dysfunction, and muscular problems and were hospitalized more frequently with otitis media, pneumonia, FAS, dehydration, and anemia. Case children were hospitalized more days than were control children. Case children were removed from their homes and placed in foster care more often than were control children. CONCLUSIONS: Children with full or incomplete FAS had many health, learning, and social needs. Health care providers and community programs should identify the needs of these children and offer optimal services to meet those needs.

Characteristics of mothers who have children with fetal alcohol syndrome or some characteristics of fetal alcohol syndrome.

BACKGROUND: Health care providers can more effectively prevent fetal alcohol syndrome and prenatal alcohol exposure if they know more about mothers who have children with fetal alcohol syndrome (FAS) or some characteristics of FAS. METHODS: We conducted two retrospective case-control studies of Northern Plains Indian children with FAS and some characteristics of FAS diagnosed from 1981 to 1993 by using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM), code 760.71. We compared mothers who had children with FAS or some characteristics of FAS with mothers who had children that did not have FAS. RESULTS: Compared with control mothers, 43 mothers who had children with FAS and 35 mothers who had children with some characteristics of FAS were older, had fewer prenatal visits, more pregnancies, more mental health problems, and more injuries (both total and alcohol-related). Although the prevalence of drinking was high in both case and control mothers, case mothers had more alcohol-related medical problems, drank heavily, in binges, and daily more often than control mothers. CONCLUSIONS: Women with injuries and mental health problems should be screened for substance use. Mothers of children with FAS or of some characteristics of FAS have numerous needs that must be addressed to prevent future prenatal alcohol exposure.