CLINICAL USE OF MECONIUM FATTY ACID ETHYL ESTERS FOR IDENTIFYING CHILDREN AT RISK FOR ALCOHOL- RELATED DISABILITIES: THE FIRST REPORTED CASE
Main Article Content
Keywords
Fatty acid ethyl esters, meconium, neonatal screening, fetal alcohol spectrum disorder, developmental follow-up
Abstract
Fatty acid ethyl esters (FAEEs) in meconium are validated biomarkers of heavy fetal alcohol exposure that may potentially be used clinically for identifying children at risk for alcohol-related disabilities. However, until now, FAEEs have been largely used anonymously in epidemiological studies, and by child protection authorities in need for verification of heavy alcohol use in pregnancy. Here we describe the first case of a neonate identified as part of a research study on a pilot neonatal screening program for prenatal alcohol exposure. The neonate’s meconium tested high for FAEEs (52 nmol/g; positive cut-off ?2 nmol/g), which prompted active follow-up of the infant’s development, identifying early neurocognitive problems and allowing initiation of a remedial program.
References
1. Sampson PD, Streissguth AP, Bookstein FL, et al. Incidence of fetal alcohol syndrome and prevalence of alcohol-related neurodevelopmental disorder. Teratology 1997;56:317-326.
2. Stade B, Ali A, Bennett D, et al. The burden of prenatal exposure to alcohol: revised measurement of cost. Can J Clin Pharmacol 2009;16:e91-e102.
3. Lupton C, Burd L, Harwood R. Cost of fetal alcohol spectrum disorders. Am J Med Genet C Semin Med Genet 2004;127C:42-50.
4. Streissguth AP, Bookstein FL, Barr HM, Sampson PD, O'Malley K, Young JK. Risk factors for adverse life outcomes in fetal alcohol syndrome and fetal alcohol effects. J Dev Behav Pediatr 2004;25: 228-238.
5. Chudley AE, Conry J, Cook JL, Loock C, Rosales T, LeBlanc N. Fetal alcohol spectrum disorder: Canadian guidelines for diagnosis. CMAJ 2005;172:S1-S21.
6. Best CA, Laposata M. Fatty acid ethyl esters: toxic non-oxidative metabolites of ethanol and markers of ethanol intake. Front Biosci 2003;8:e202-e217.
7. Koren G, Hutson J, Gareri J. Novel methods for the detection of drug and alcohol exposure during pregnancy: implications for maternal and child health. Clin Pharmacol Ther 2008;83:631- 634.
8. Bearer CF, Jacobson JL, Jacobson SW, et al. Validation of a new biomarker of fetal exposure to alcohol. J Pediatr 2003;143:463-469.
9. Bearer CF, Santiago LM, O'Riordan MA, Buck K, Lee SC, Singer LT. Fatty Acid ethyl esters: quantitative biomarkers for maternal alcohol consumption. J Pediatr 2005;146:824-830.
10. Chan D, Bar-Oz B, Pellerin B, et al. Population baseline of meconium fatty acid ethyl esters among infants of nondrinking women in Jerusalem and Toronto. Ther Drug Monit 2003 Jun;25:271-8.
11. Ostrea EM Jr., Hernandez JD, Bielawski DM, et al. Fatty acid ethyl esters in meconium: are they biomarkers of fetal alcohol exposure and effect? Alcohol Clin Exp Res 2006;30:1152-1159.
12. Gareri J, Lynn H, Handley M, Rao C, Koren G. Prevalence of fetal ethanol exposure in a regional population-based sample by meconium analysis of fatty acid ethyl esters. Ther Drug Monit 2008; 30:239-245.
13. Hutson J, Magri R, Suarez H, Miguez H, Gareri J, Koren G. High prevalence of prenatal exposure to alcohol and other drugs of abuse in Uruguay as determined by meconium analysis. Alcohol Clin Exp Res 2007;31:718A.
14. Goh YI, Hutson JR, Lum L, et al. Rates of fetal alcohol exposure among newborns in a high-risk obstetric unit. Alcohol 2010;44:629-634.
15. Goh YI, Chudley AE, Clarren SK, et al. Development of Canadian screening tools for fetal alcohol spectrum disorder. Can J Clin Pharmacol 2008;15:e344-e366.
16. Zelner I, Shor S, Gareri J, et al. Universal screening for prenatal alcohol exposure: a progress report of a pilot study in the region of Grey Bruce, Ontario. Ther Drug Monit 2010;32:305-310.
17. Hutson JR, Aleksa K, Pragst F, Koren G. Detection and quantification of fatty acid ethyl esters in meconium by headspace-solid-phase microextraction and gas chromatography-mass spectrometry. J Chromatogr B Analyt Technol Biomed Life Sci 2009;877:8-12.
18. Ontario Ministry of Health and Long-Term Care. Healthy Babies Healthy Children Report Card. (June, 2003) http://www.health.gov.on.ca/english/public/pub/ ministry_reports/healthy_babies_report/hbabies_ report.html (July 25, 2011).
19. Bearer CF, Lee S, Salvator AE, et al. Ethyl linoleate in meconium: a biomarker for prenatal ethanol exposure. Alcohol Clin Exp Res 1999;23:487-493.
20. Mattson SN, Riley EP. A review of the neurobehavioral deficits in children with fetal alcohol syndrome or prenatal exposure to alcohol. Alcohol Clin Exp Res 1998;22:279- 294.
21. O'Leary CM. Fetal alcohol syndrome: diagnosis, epidemiology, and developmental outcomes. J Paediatr Child Health 2004;40:2-7.
22. Kalberg WO, Provost B, Tollison SJ, et al. Comparison of motor delays in young children with fetal alcohol syndrome to those with prenatal alcohol exposure and with no prenatal alcohol exposure. Alcohol Clin Exp Res 2006;30:2037-2045.
23. Wacha VH, Obrzut JE. Effects of Fetal Alcohol Syndrome On Neuropsychological Function . J Dev Phys Disabil 2007;19:217-226.
24. Meyer LS, Kotch LE, Riley EP. Alterations in gait following ethanol exposure during the brain growth spurt in rats. Alcohol Clin Exp Res 1990;14:23-27.
25. Thomas JD, Wasserman EA, West JR, Goodlett CR. Behavioral deficits induced by bingelike exposure to alcohol in neonatal rats: importance of developmental timing and number of episodes. Dev Psychobiol 1996;29:433-452.
26. Coggins TE, Timler GR, Olswang LB. A state of double jeopardy: impact of prenatal alcohol exposure and adverse environments on the social communicative abilities of school-age children with fetal alcohol spectrum disorder. Lang Speech Hear Serv Sch 2007;38:117-127.
27. Wyper KR, Rasmussen CR. Language impairments in children with fetal alcohol spectrum disorders. J Popul Ther Clin Pharmacol 2011;18:e364-e376.
28. McGee CL, Bjorkquist OA, Riley EP, Mattson SN. Impaired language performance in young children with heavy prenatal alcohol exposure. Neurotoxicol Teratol 2009;31:71-75.
29. Peterson J, Kirchner HL, Xue W, Minnes S, Singer LT, Bearer CF. Fatty acid ethyl esters in meconium are associated with poorer neurodevelopmental outcomes to two years of age. J Pediatr 2008;152:788-792.
30. Hicks MS. Meconium Alcohol and Drug Screening. PhD Thesis. Calgary, Alberta, University of Calgary, 2007.
31. Bertrand J. Interventions for children with fetal alcohol spectrum disorders (FASDs): overview of findings for five innovative research projects. Res Dev Disabil 2009;30:986-1006.
32. Peadon E, Rhys-Jones B, Bower C, Elliott EJ. Systematic review of interventions for children with Fetal Alcohol Spectrum Disorders. BMC Pediatr 2009;9:35.
2. Stade B, Ali A, Bennett D, et al. The burden of prenatal exposure to alcohol: revised measurement of cost. Can J Clin Pharmacol 2009;16:e91-e102.
3. Lupton C, Burd L, Harwood R. Cost of fetal alcohol spectrum disorders. Am J Med Genet C Semin Med Genet 2004;127C:42-50.
4. Streissguth AP, Bookstein FL, Barr HM, Sampson PD, O'Malley K, Young JK. Risk factors for adverse life outcomes in fetal alcohol syndrome and fetal alcohol effects. J Dev Behav Pediatr 2004;25: 228-238.
5. Chudley AE, Conry J, Cook JL, Loock C, Rosales T, LeBlanc N. Fetal alcohol spectrum disorder: Canadian guidelines for diagnosis. CMAJ 2005;172:S1-S21.
6. Best CA, Laposata M. Fatty acid ethyl esters: toxic non-oxidative metabolites of ethanol and markers of ethanol intake. Front Biosci 2003;8:e202-e217.
7. Koren G, Hutson J, Gareri J. Novel methods for the detection of drug and alcohol exposure during pregnancy: implications for maternal and child health. Clin Pharmacol Ther 2008;83:631- 634.
8. Bearer CF, Jacobson JL, Jacobson SW, et al. Validation of a new biomarker of fetal exposure to alcohol. J Pediatr 2003;143:463-469.
9. Bearer CF, Santiago LM, O'Riordan MA, Buck K, Lee SC, Singer LT. Fatty Acid ethyl esters: quantitative biomarkers for maternal alcohol consumption. J Pediatr 2005;146:824-830.
10. Chan D, Bar-Oz B, Pellerin B, et al. Population baseline of meconium fatty acid ethyl esters among infants of nondrinking women in Jerusalem and Toronto. Ther Drug Monit 2003 Jun;25:271-8.
11. Ostrea EM Jr., Hernandez JD, Bielawski DM, et al. Fatty acid ethyl esters in meconium: are they biomarkers of fetal alcohol exposure and effect? Alcohol Clin Exp Res 2006;30:1152-1159.
12. Gareri J, Lynn H, Handley M, Rao C, Koren G. Prevalence of fetal ethanol exposure in a regional population-based sample by meconium analysis of fatty acid ethyl esters. Ther Drug Monit 2008; 30:239-245.
13. Hutson J, Magri R, Suarez H, Miguez H, Gareri J, Koren G. High prevalence of prenatal exposure to alcohol and other drugs of abuse in Uruguay as determined by meconium analysis. Alcohol Clin Exp Res 2007;31:718A.
14. Goh YI, Hutson JR, Lum L, et al. Rates of fetal alcohol exposure among newborns in a high-risk obstetric unit. Alcohol 2010;44:629-634.
15. Goh YI, Chudley AE, Clarren SK, et al. Development of Canadian screening tools for fetal alcohol spectrum disorder. Can J Clin Pharmacol 2008;15:e344-e366.
16. Zelner I, Shor S, Gareri J, et al. Universal screening for prenatal alcohol exposure: a progress report of a pilot study in the region of Grey Bruce, Ontario. Ther Drug Monit 2010;32:305-310.
17. Hutson JR, Aleksa K, Pragst F, Koren G. Detection and quantification of fatty acid ethyl esters in meconium by headspace-solid-phase microextraction and gas chromatography-mass spectrometry. J Chromatogr B Analyt Technol Biomed Life Sci 2009;877:8-12.
18. Ontario Ministry of Health and Long-Term Care. Healthy Babies Healthy Children Report Card. (June, 2003) http://www.health.gov.on.ca/english/public/pub/ ministry_reports/healthy_babies_report/hbabies_ report.html (July 25, 2011).
19. Bearer CF, Lee S, Salvator AE, et al. Ethyl linoleate in meconium: a biomarker for prenatal ethanol exposure. Alcohol Clin Exp Res 1999;23:487-493.
20. Mattson SN, Riley EP. A review of the neurobehavioral deficits in children with fetal alcohol syndrome or prenatal exposure to alcohol. Alcohol Clin Exp Res 1998;22:279- 294.
21. O'Leary CM. Fetal alcohol syndrome: diagnosis, epidemiology, and developmental outcomes. J Paediatr Child Health 2004;40:2-7.
22. Kalberg WO, Provost B, Tollison SJ, et al. Comparison of motor delays in young children with fetal alcohol syndrome to those with prenatal alcohol exposure and with no prenatal alcohol exposure. Alcohol Clin Exp Res 2006;30:2037-2045.
23. Wacha VH, Obrzut JE. Effects of Fetal Alcohol Syndrome On Neuropsychological Function . J Dev Phys Disabil 2007;19:217-226.
24. Meyer LS, Kotch LE, Riley EP. Alterations in gait following ethanol exposure during the brain growth spurt in rats. Alcohol Clin Exp Res 1990;14:23-27.
25. Thomas JD, Wasserman EA, West JR, Goodlett CR. Behavioral deficits induced by bingelike exposure to alcohol in neonatal rats: importance of developmental timing and number of episodes. Dev Psychobiol 1996;29:433-452.
26. Coggins TE, Timler GR, Olswang LB. A state of double jeopardy: impact of prenatal alcohol exposure and adverse environments on the social communicative abilities of school-age children with fetal alcohol spectrum disorder. Lang Speech Hear Serv Sch 2007;38:117-127.
27. Wyper KR, Rasmussen CR. Language impairments in children with fetal alcohol spectrum disorders. J Popul Ther Clin Pharmacol 2011;18:e364-e376.
28. McGee CL, Bjorkquist OA, Riley EP, Mattson SN. Impaired language performance in young children with heavy prenatal alcohol exposure. Neurotoxicol Teratol 2009;31:71-75.
29. Peterson J, Kirchner HL, Xue W, Minnes S, Singer LT, Bearer CF. Fatty acid ethyl esters in meconium are associated with poorer neurodevelopmental outcomes to two years of age. J Pediatr 2008;152:788-792.
30. Hicks MS. Meconium Alcohol and Drug Screening. PhD Thesis. Calgary, Alberta, University of Calgary, 2007.
31. Bertrand J. Interventions for children with fetal alcohol spectrum disorders (FASDs): overview of findings for five innovative research projects. Res Dev Disabil 2009;30:986-1006.
32. Peadon E, Rhys-Jones B, Bower C, Elliott EJ. Systematic review of interventions for children with Fetal Alcohol Spectrum Disorders. BMC Pediatr 2009;9:35.