Original Work

By Andrea Torres Rodarte

Table Of Contents

Torres Rodarte 1
Original Work Introduction -------------------------------------------------- 3-4

Introduction----------------------------------------------------------3

Fictional Case Report Layout-------------------------------------4

Clinical Case Report-------------------------------------------------------------5-14

Abstract-----------------------------------------------------------------------6-7

Introduction------------------------------------------------------------------7-8

Case--------------------------------------------------------------------------8-13

Discussion------------------------------------------------------------------13-14

Conclusion------------------------------------------------------------------14-15

References--------------------------------------------------------------------------15-18

Thank you--------------------------------------------------------------------------19

Torres Rodarte 2
 Introduction

It is basic information on the importance of staying abstinent from alcohol

during pregnancy. Even without being pregnant, we are all well-versed our whole

lives on the consequences that come with falling down the road of substance abuse

and the damage it may cause to our bodies. However, very few people know the

exact reason why medical professionals like neonatologists and neonatal nurse

practitioners fight to caution mothers against the dangers of prenatal alcohol

consumption.

During pregnancy, it is vital for a mother to make the effort of avoiding the

use of substances in order to protect the health and well-being of their baby. This is

the only way to prevent the possibility of Fetal Alcohol Syndrome Disorders.

Recent studies have shown the symptoms and the outcomes of babies who were

born with these disorders and we have also advanced in research on the long-term

outcomes.

Education must be provided for mothers to be aware of why they are making

the sacrifices that they are in order to prevent the rise of FAD (Fetal Alcohol

Syndrome). Furthermore, to educate the public as a whole in order to provide

better support for expecting mothers who may be currently struggling with

substance abuse, or maybe thinking of giving in to substance abuse. The purpose of

Torres Rodarte 3
my clinical case reports is to be a community resource to further educate expecting

mothers on the importance of abstinence from alcohol to protect both their own

health and the health of their baby. And to bring awareness to this subject, in

general, to potentially offer more resources and support to mothers in need.

Fictional Clinical Case Reports Layouts

I will be creating a miniature version of a research clinical case report in

order to showcase the effects of substance abuse on a fetus. Although case reports

are typically used to present new medical outcomes or groundbreaking discoveries

this case will be solely for educational purposes. These case studies are completely

fictional and are based on research in order to compare the different treatments and

symptoms. Although this is a fictional case I decided to still treat the case as if it

were real. That is why I included disclaimers for consent and included a

watered-down version of the discussion part. In that part, I argued for the

publication of my research study despite it not being considered something new.

Clinical Research cases are typically only made when documenting a

groundbreaking case or abnormality that deserved to be published. However, when

deciding how I wanted to format my research I decided I wanted to apply it to a

real-life scenario as much as possible while still showcasing my research on Fetal

Torres Rodarte 4
Alcohol Syndrome. That is why I decided to take the format of a clinical research

case to report my findings.

Torres Rodarte 5
 Baby A (Austin)

Clinical Case Report Fetal Alcohol Syndrome

Torres Rodarte 6
Abstract
Rationale

The Effects of Alcohol on a fetus can cause a variety of complications to not

just the baby but the mother as well. Alcohol use during pregnancy can lead to

prematurity, stillbirth, miscarriage, and infant death in exaggerated amounts.

Herein, I report the birth of a premature baby to a mother struggling with

Alcohol Abuse with no other underlying conditions.

Concerns

Parents and family are concerned about the quality of life the neonate will be

facing and the treatment they will be receiving in the NICU.

Diagnoses

After three days of observation in the NICU, the patient was diagnosed by

the attending Neonatologist with Fetal Alcohol Syndrome ‘

Treatment

There is no standing treatment for Fetal Alcohol Syndrome. The patient was

treated with intensive therapy in order to aid with the withdrawal from the ethanol

and observed in the NICU in order to monitor the stimulation levels of the

Neonate.

Outcome

Torres Rodarte 7
 The patient was released from the NICU with the same diagnosis once

withdrawal symptoms had ceased. The patient was found to have long-term

Neurological and Physical defects.

Introduction
According to the National Institute on Alcohol Abuse and Alcoholism, 20% to

30% of women have reported drinking at some point during their pregnancy and

8% have had at least one binge of alcohol during their pregnancy. Some of the

more common effects of alcohol abuse during pregnancy are neurological and

physical setbacks categorized into Fetal Alcohol Syndrome. Although the NIAAA

defines an Alcohol binge as over .08 percent, lower dosages can cause the same

problems. Due to the fetus's dependence on the mother's diet for the proper

nutrients, alcohol is passed easily through the bloodstream which can interfere with

the brain, critical organs, and the Physiological system of the neonate. As alcohol

passes the bloodstream and enters the placenta it disrupts the fetus's delivery of

oxygen and nutrients to the growing tissue responsible for forming vital organs.

This can include tissues like the heart, brain, and most commonly seen the

neonate's physical structure.

Torres Rodarte 8
 Fetal Alcohol Syndrome most commonly presents itself as a neurological

condition as the neonate enters childhood, however, it can also have many physical

side effects at this time as well. In fact, Advanced Imaging studies have shown “

differences in brain structure and activity that are consistent with data from

neuropsychological testing” (NIAAA 3). As neonates, Neurological disorders are

not as visible as physical aspects. However, both can still be present.

Case
History and Records

The family of the Patient has provided consent for the public release of this

case.

In the case of Neonate Austin, in 2021 his mother admitted to consistent use

of alcohol abuse and alcohol binging during the 30-week period concentrated

around the first trimester. Baby Austin was born prematurely at 30 weeks and was

a natural birth with no complications during the birth itself. The mother had done

an acceptable job staying up to date with medical visits with her OB/GYN and

taking some of the recommended Prenatal vitamins along with an overall healthy

diet. His mother has no past medical history or important family history aside from

alcohol abuse which has been constant throughout her life. Austin’s Birthing staff

Torres Rodarte 9
was made aware of the possibility of FAS and the neonate was immediately taken

away for testing and care. Furthermore, the attending OB/GYN requested the

presence of the full team in the room during the birth to aid with any possible

complications with the babies breathing or heart rate. Austin was diagnosed with

FAS and was found to have many physical defects at birth along with some

neurological defects.

Diagnosis Process

Austin is presented to have a low birth weight of 3 pounds 5 ounces, an

irregularly small shaped head, and abnormal facial features like small eye-opening,

Minor ear abnormalities, and a smooth philtrum. The Neonate quickly became

agitated and responded negatively to the lights of the NICU and the sensation of

touch from the mother / NICU staff. There is no current blood work diagnosis for

FAS so the Neonatologist diagnosed the patient based on the five key indicators of

FAS. These include distinctive facial features, slow growth, growth retardation,

admitted maternal alcohol consumption, and central nervous system abnormalities.

The neonate presented all of the characteristics after birth and during their

examinations in the NICU leading to his diagnosis. The Neonate's distinct features

were a strong indication of the severity of the case placing it on the more critical

side of the spectrum. Physical defects are proof of Central Nervous System

Torres Rodarte 10
Abnormalities that can lead to a diagnosis of Alcohol-Related Neurodevelopmental

Disorders.

The smoothness of the patient's philtrum potentially predicts volumetric

reductions in the thalamus and left palladium. The patient's distinct features further

established a linear relationship with the growth of the cerebral cortex which can

continue past childhood into adolescence.

Treatment

There is no standing treatment for Fetal Alcohol Syndrome in the medical

field. The Neonate was cared for in the Neonatal Intensive Care Unit for 5 weeks

in order to conduct testing and monitor the patient's vital signs, stimulation level,

and nutrition.

The patient’s weight was closely monitored by NICU staff to promote an

increase in weight. The neonatologist established a formula-based feeding schedule

as well as a variety of added nutrients in order to increase the baby's weight to

above 3 pounds 5 ounces. Although breast milk is the optimal choice for weight

gain due to the mother's condition, formula milk was decided to be the best choice

for the patient's diet. Proper nutrition is the key to treating the neurological damage

caused by high ethanol levels. The neonate was placed on a high-calorie

consumption diet to promote IQ points and to make up for lost calories. Due to the

baby's constant stimulation and convulsions, the baby was losing more calories

Torres Rodarte 11
than the amount their intake level was providing. In order to treat possible weight

loss the baby was tightly swaddled and was on a feeding tube to ensure proper

intake.

The patient's respiratory rate was highly monitored to watch for a possible

case of Apnea. The patient showed to have a low Spo2 level that would drop below

90% saturation which could potentially lead to the risk of brain damage. The baby

was placed on respiratory help on CPAP in order to monitor their oxygen intake

levels.

Pulse rate and blood pressure were also monitored during this time to look

for any indications of possible heart damage and vasoconstriction or vasodilation

in the blood vessels. As a result of withdrawal, the patient exhibited an irregular

heartbeat which was treated with a dose of Digoxin, a therapeutic drug used to

bring that heart rate back to a steady rate.

When it came to the monitoring of the patient's stimulation the patient was in

a constant state of discomfort for most of the day in the NICU. The neonate

exhibited postural arching, as well as high-pitched wails, and tremors. These

symptoms recurred in the first week of the stay and were consistent during exams.

In order to reduce the level of stimulation lights were kept low, physical contact

was kept at a minimum, and the room was kept as quiet as possible. Neonate was

also given eye covering and was tightly swaddled to mimic the mother's womb and

Torres Rodarte 12
reduce their level of stimulation These were all therapeutic tactics to help keep the

baby's agitation at a minimum to prevent self-inflicted injury. Therapeutic practices

and Monitoring were the only levels of treatment performed due to there being no

cure. The attending neonatologist educated the family on the possible neurological

stepbacks and the steps to be taken for the further treatment necessary throughout

childhood and adolescence.

Lastly, after discharge instructions were provided to the parents with the

proper care necessary to continue treatment at home for the neonate. Due to there

being no cure for FAS a lot of treatment was to be done at home after their stay in

the NICU. The neonatologist recommended that the parents continue sticking to

the baby's strict feeding schedule in order to aid with growth and development

defects caused by FAS. Continuing the therapeutic practices of swaddling, low

lights and noise will aid with the stimulation that can lead to convulsions and

inflict injury. A constant state of monitoring at home was recommended to measure

the state of the neonate's cognitive state as they transition into childhood. Lastly, it

is highly encouraged to keep the neonates updated in visits with their

neonatologist, pediatrician, child therapist, and psychiatrist.

Torres Rodarte 13
Discussion
Alcohol consumption is growing among young mothers due to its easy

access as well as social appeal. It is vital for research on Prenatal Alcohol

consumption to be spread to further prevent cases of Fetal Alcohol Syndrome.

Publishing a case study on the treatment and diagnosis of a neonate affected by

Prenatal intoxication presents the severity of cases like these despite them not

being crucial medical breakthroughs. Cases like these deserve to be put out in the

public eye to raise awareness and provide support for struggling mothers.

Furthermore, educate the general public on why we stress so much the importance

of Ethanol abstinence during pregnancy. Reaching out to the public could lead to

increased funding in support centers as well, promote intervention, and create

greater research to help those currently struggling with Fetal Alcohol Syndrome.

Conclusion
In the case of baby Austin he left the NICU after the 5 weeks period and has

been living at home under the care of his parents. Due to his mother's condition, his

living situation is also being monitored as well as his growth and development.

These factors ensure that the baby is receiving the proper care at home and does

not risk a possible case of neglect. Neurological diagnosis can be expected but is

Torres Rodarte 14
typically not diagnosed until later in childhood. It is vital for the family to monitor

the baby for possible signs of ADHD, ADD, learning retardation, anxiety,

depression, and other Neurobehavioral/ Neurological conditions. These conditions

are probable based on the amount of alcohol intake in the months of the first

trimester.

Due to the presence of central nervous system damage, Austin will have

various cognitive issues. He will struggle with being social and interacting with

others, especially in childhood and adolescence. Furthermore, he will struggle with

retaining information and applying it in school or in everyday activities. He will

also present poor short-term memory, delayed speech, and poor judgment skills.

These conditions will cause a setback in his life, but can be aided with the help of a

childhood therapist, psychiatrist, and learning development coach.

Lastly, Austin will face physical defects for the rest of his life. He will most

likely present signs of poor coordination, below-average height, and low weight for

the entirety of his life. Furthermore, his facial features are irreversible and will

continue to be prominent.

Torres Rodarte 15
References
Advances in Diagnosis and Treatment of Fetal Alcohol Spectrum Disorders: From

Animal Models to Human Studies. (n.d.). NCBI. Retrieved December 16,

2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4476607/

Ban, -. E. (2017, November 27). Neonatal arrhythmias: diagnosis, treatment, and

clinical outcome. NCBI. Retrieved December 16, 2022, from

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5725339/

BMC Pregnancy and Childbirth | Case report. (n.d.). BMC Pregnancy and

Childbirth. Retrieved December 16, 2022, from

Advances in Diagnosis and Treatment of Fetal Alcohol Spectrum Disorders: From

Animal Models to Human Studies. (n.d.). NCBI. Retrieved December 16,

2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4476607/

Ban, -. E. (2017, November 27). Neonatal arrhythmias: diagnosis, treatment, and

clinical outcome. NCBI. Retrieved December 16, 2022, from

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5725339/

BMC Pregnancy and Childbirth | Case report. (n.d.). BMC Pregnancy and

Childbirth. Retrieved December 16, 2022, from

https://bmcpregnancychildbirth.biomedcentral.com/submission-guidelines/pr

eparing-your-manuscript/case-report

Torres Rodarte 16
Bradycardia and Apnea in Premature Babies. (2022, September 15). Verywell

Health. Retrieved December 16, 2022, from

https://www.verywellhealth.com/what-are-apnea-and-bradycardia-2748619

Fetal Alcohol Exposure | National Institute on Alcohol Abuse and Alcoholism

(NIAAA). (n.d.). National Institute on Alcohol Abuse and Alcoholism

(NIAAA). Retrieved December 16, 2022, from

https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/fetal-alcoh

ol-exposure

Fetal Alcohol Syndrome (FAS): Symptoms, Causes & Treatment. (2022, February

16). Cleveland Clinic. Retrieved December 16, 2022, from

https://my.clevelandclinic.org/health/diseases/15677-fetal-alcohol-syndrome

FFF Fetal Alcohol Syndrome (FAS). (n.d.). AACAP. Retrieved December 16,

2022, from

https://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FF

F-Guide/Fetal_Alcohol_Syndrome-134.aspx

Guidelines To Writing A Clinical Case Report. (n.d.). NCBI. Retrieved December

16, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5686928/

https://bmcpregnancychildbirth.biomedcentral.com/submission-guidelines/preparin

g-your-manuscript/case-report

Torres Rodarte 17
Fetal Alcohol Exposure | National Institute on Alcohol Abuse and Alcoholism

(NIAAA). (n.d.). National Institute on Alcohol Abuse and Alcoholism

(NIAAA). Retrieved December 16, 2022, from

https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/fetal-alcoh

ol-exposure

Fetal Alcohol Syndrome (FAS): Symptoms, Causes & Treatment. (2022, February

16). Cleveland Clinic. Retrieved December 16, 2022, from

https://my.clevelandclinic.org/health/diseases/15677-fetal-alcohol-syndrome

FFF Fetal Alcohol Syndrome (FAS). (n.d.). AACAP. Retrieved December 16,

2022, from

https://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FF

F-Guide/Fetal_Alcohol_Syndrome-134.aspx

Guidelines To Writing A Clinical Case Report. (n.d.). NCBI. Retrieved December

16, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5686928/

Torres Rodarte 18
Thank you

Torres Rodarte 19