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In addition to other organic syndromes that produce deficits in one or more of the previously cited domains hiv infection probability purchase genuine minipress online. Documentation and confirmation of prenatal alcohol exposure can be extremely challenging hiv infection lymph nodes quality 2 mg minipress. For birth mothers, admission of alcohol use during pregnancy can be very stigmatizing. The situation can be further complicated if the woman is still using alcohol, especially at high consumption rates. In this situation, information about alcohol use might need to be obtained from other reliable informants, such as a relative. It must be noted that simple denials of alcohol use might or might not be credible and corroborating evidence should be obtained whenever possible. Confirmed prenatal alcohol exposure requires documentation of the alcohol consumption patterns of the birth mother during the index pregnancy based on clinical observation; selfreport; reports of heavy alcohol use during pregnancy by a reliable informant; medical records documenting positive blood alcohol levels, or alcohol treatment; or other social, legal, or medical problems related to drinking during the index pregnancy. Unknown prenatal alcohol exposure indicates that there is neither a confirmed presence nor a confirmed absence of exposure. Examples include: the child is adopted and prenatal exposure(s) is unknown; the birth mother is an alcoholic, but confirmed evidence of exposure during pregnancy does not exist; and conflicting reports about exposure exist that cannot be reliably resolved. Documentation of all three facial abnormalities (smooth philtrum, thin vermillion border, and small palpebral fissures); 2. It should be noted that confirmed prenatal alcohol use can strengthen the evidence for diagnosis, but is not necessary in the presence of all the previous findings. As would be expected for any congenital syn drome, presentation of the diagnostic features can change over development. With regards to facial features (small palpebral fissures, smooth philtrum, and thin vermillion border), it has generally been accepted that these features are most evident during infancy and the early preschool years. However, longitudinal data that specifically address this issue are not available currently. One also might expect growth parameters to change (and generally normalize) with development. This might especially be the case for children who receive nutritional or other interventions. While structural abnormalities would remain consistent, neurological and functional deficits could resolve or change presentation at various stages of development. During the newborn and infancy periods, difficulty with arousal or behavior regulation might be observed. For example, simple planning or organization skills are learned, as well as understanding the physical and mental perspective of others. During adolescence and through adulthood, the pattern of deficits continues to be present and in addition, lifelong conse 19 Fetal Alcohol Syndrome: Guidelines for Referral and Diagnosis Table 3: Brief Outline of Diagnostic criteria for Fetal Alcohol Syndrome Facial dysmorphia Based on racial norms, individual exhibits all three characteristic facial features: · Smooth philtrum (University of Washington Lip-Philtrum Guide rank 4 or 5) · Thin vermillion border (University of Washington Lip-Philtrum Guide rank 4 or 5) · Small palpebral fissures (at or below 10th percentile) Growth problems Confirmed prenatal or postnatal height or weight, or both, at or below the 10th percentile, documented at any one point in time (adjusted for age, sex, gestational age, and race or ethnici ty). Neurological Neurological problems not due to a postnatal insult or fever, or other soft neurological signs outside normal limits. As future data and science are avail able, these guidelines can be refined and expanded to delineate other conditions resulting from pre natal alcohol exposure. For biological families, there may be social stigma associated with any evaluation concerning prenatal alcohol exposure. In other families, direct information about alcohol use during pregnancy may not be available or only sus pected. Thus, the following guidelines were developed to provide assistance in making the referral decision, although, it is recognized that each case must be evaluated individually. Further, these guidelines were developed with the idea that when in doubt, it was preferable to refer for full evalu ation by a multidisciplinary team with experience in evaluating prenatal alcohol exposure. If prenatal alcohol exposure in the high risk range is known in the absence of any other positive screening criteria, the primary healthcare provider should document this exposure and closely monitor the childs ongoing growth and development. Thus, serv ice needs for any particular individual and his or her family can be quite individualistic (140).

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