Robert Monique, Carceller Ana, Domken Valérie, Ramos Félix, Dobrescu Otilia, Simard Marie-Noëlle, Gosselin Julie
Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Canada.
Can J Clin Pharmacol. 2009 Fall;16(3):e432-40. Epub 2009 Oct 29.
Children adopted from Eastern Europe are at risk of prenatal alcohol exposure, consequently at risk of Fetal Alcohol Spectrum Disorders (FASD). To our knowledge, a systematic complete assessment of these disabilities among adoptees from Eastern Europe has not yet been reported.
To assess physical and neurodevelopmental status to identify FASD in children adopted from Eastern Europe.
Cross sectional study at International Adoption Clinic of a paediatric academic hospital. This evaluation was realized according to the 4-Digit Diagnostic Code (4-DDC).
Twenty-nine children were evaluated. Five years after adoption, 7% (N=2) still presented growth delay and 24% (N=7) microcephaly. Facial evaluation demonstrated moderate Fetal Alcohol Syndrome (FAS) features in 7% (N=2) of children. Amiel-Tison Neurological Assessment was non optimal in 46% (N=13/28) of children. Visual-motor perception skills were mainly normal, but 14% (N=4) showed distal somatopraxic problems. Cognition, executive functioning, abstract reasoning and memory were normal. Full scale IQ was 105.5 +/- 13.3; verbal IQ < performance IQ (p<0.005), work memory < short memory (p<0.0001), receptive <expressive language (p<0.0001). Attention-deficit hyperactive disorder was presented in 31% (N=9). Concerning adaptive behaviour, social skills and social communication, 29% (N=8) performed <-2 SD and 33% (N=5/15) needed school assistance. According to 4-DDC, 7% (N=2) of children were normal, 21% (N=6) of children were known exposed to alcohol, one of these was classified as Partial FAS and five others presented neurological damage, or neurobehavioral disorders with or without sentinel physical findings. Three percent (N=1) were classified FAS although alcohol exposure was unknown. Sixty-nine percent (N=20) of children presented physical findings alone or neurological anomalies with or without physical findings.
In our cohort, the 4-DDC was useful. Systematic and multidisciplinary neurodevelopmental assessment is needed in these adopted children, for an early intervention to prevent secondary disabilities and therefore optimize children's outcome.
从东欧收养的儿童有产前酒精暴露风险，因此有患胎儿酒精谱系障碍（FASD）的风险。据我们所知，尚未有关于对来自东欧的被收养儿童中这些残疾情况进行系统全面评估的报告。
评估从东欧收养的儿童的身体和神经发育状况，以确定是否患有FASD。
在一家儿科教学医院的国际收养诊所进行横断面研究。该评估依据四位数诊断编码（4-DDC）进行。
对29名儿童进行了评估。收养五年后，7%（N = 2）的儿童仍存在生长发育迟缓，24%（N = 7）的儿童有小头畸形。面部评估显示7%（N = 2）的儿童有中度胎儿酒精综合征（FAS）特征。46%（N = 13/28）的儿童阿米尔-蒂森神经学评估结果不理想。视动感知技能大多正常，但14%（N = 4）的儿童存在远端肢体运用障碍问题。认知、执行功能、抽象推理和记忆均正常。全量表智商为105.5±13.3；言语智商<操作智商（p<0.005），工作记忆<短时记忆（p<0.0001），接受性语言<表达性语言（p<0.0001）。31%（N = 9）的儿童患有注意力缺陷多动障碍。关于适应性行为、社交技能和社交沟通，29%（N = 8）的儿童表现低于-2标准差，33%（N = 5/15）的儿童需要学校提供帮助。根据4-DDC，7%（N = 2）的儿童正常，21%（N = 6）的儿童已知有酒精暴露史，其中一名被归类为部分FAS，另外五名存在神经损伤或神经行为障碍，伴有或不伴有标志性身体体征。3%（N = 1）的儿童被归类为FAS，但酒精暴露情况未知。69%（N = 20）的儿童单独存在身体体征或伴有或不伴有身体体征的神经异常。
在我们的队列中，4-DDC是有用的。对于这些被收养儿童，需要进行系统的多学科神经发育评估，以便早期干预以预防继发性残疾，从而优化儿童的预后。
