Current Problems in Pediatric and Adolescent Health Care最新文献

Fetal Alcohol Spectrum Disorders (FASD) comprise a continuum of neurodevelopmental and physical disabilities resulting from the teratogenic effects of prenatal alcohol exposure. FASD is recognized as the leading cause of preventable developmental disabilities worldwide. Recent U.S. school-based studies estimate its prevalence at 11.3-50.0 per 1000 children (approximately 1-5 %), with rates in certain high-risk populations reaching up to 169 per 1000 (approximately 17 %). Although early diagnosis is associated with improved long-term outcomes, FASD remains frequently underrecognized or misdiagnosed. Multiple factors contribute to this gap, including a shortage of specialized multidisciplinary diagnostic teams and the absence of a universally accepted diagnostic framework. This narrative review examines recent advances in the clinical diagnosis of FASD and highlights areas for future research aimed at improving diagnostic precision. The evidence presented underscores a clear public health message: abstaining from alcohol consumption during pregnancy is the safest and most effective strategy to prevent FASD.

The evaluation and management of children with prenatal alcohol exposure and suspected fetal alcohol spectrum disorders (FASD) requires a multidisciplinary approach, grounded in the pediatric medical home. This process begins with the primary care provider who is often the initial point of contact for children presenting with developmental and behavioral concerns. An evaluation for a FASD requires the primary care provider to consider the effects of biological risk factors (e.g. genetic and mental health risks, maternal pregnancy risks, and history or prenatal substance exposures), and the role of co-occurring complex trauma, for which a trauma-informed, family-centered approach is necessary to mitigate secondary morbidities, and optimize future outcomes. In this article, we will present a holistic approach to evaluating a child with a suspected alcohol-related diagnosis, beginning with the diagnostic interview which centers on building a therapeutic alliance with the child and family grounded in a framework of trauma-informed care. We will consider the role of equifinality and multifinality in the evaluation of children with developmental and behavioral concerns and suspected prenatal alcohol exposure. We will briefly review the Collaboration on FASD Prevalence (CoFASP) Clinical Diagnostic Guidelines for FASD, and review the neurobehavioral deficits associated with prenatal alcohol exposure and their developmental emergence across the childhood spectrum, with suggestions for monitoring and intervention in primary care. We will also highlight neurobehavioral similarities between FASDs and other neurodevelopmental disorders, and we will discuss the importance of trauma-informed care to foster resilience and optimize future outcomes across the developmental lifespan in children and families with FASDs.

The last two decades have witnessed a remarkable transformation in the integration of artificial intelligence in healthcare. Similarly, our understanding of fetal alcohol spectrum disorders (FASD) has expanded and the data points now being considered are far more granular. In this article, we will review how investigators have attempted to apply technological innovations to enhance our knowledge of FASD and to fill some of the gaps that exist regarding access to experienced diagnosticians. We will summarize the salient studies to date and highlight future directions in terms of how the technology can move from research to healthcare delivery.