Porencephaly in an Italian neonate with foetal alcohol spectrum disorder

Abstract

Introduction: Foetal alcohol spectrum disorder (FASD) is a complex malformative disease caused by the teratogenic effect of alcohol consumed during pregnancy. Mothers are frequently reluctant to admit alcohol consumption during pregnancy. During infancy and particularly during neonatal period, differential diagnosis is difficult. Patient concerns: This case is represented by an Italian neonate boy small for gestational age, born by caesarean section at a gestational age of 37 weeks + 6 days by neglect and single-parent pregnancy. On physical examination, he presented particular facial features: microcephaly, epicanthal folds, flat midface, low nasal bridge, indistinct philtrum, and thin upper lip; moreover, examination revealed a macro-penis and recurvation without evidence of glans. Diagnosis: Echocardiogram showed an inter-ventricular defect of medium-muscular type and brain magnetic resonance imaging showed asymmetry of the cerebral hemispheres with hypoplasia of the left cerebral hemisphere, dilatation of the left ventricle, cerebrospinal fluid cavity, and porencephaly. Interventions: We investigated the ethylglucuronide (EtG) concentration in the neonate's hair by liquid chromatography-tandem mass spectrometry and we detected EtG in the infant's hair (normal value, 30 pg/mg), demonstrating prenatal alcohol exposure. Outcomes: In this neonate, EtG measure in hairs permitted the diagnosis of FASD, so allowing to exclude genetic diseases associated with similar clinical findings. After this result the mother admitted that she drunk alcohol during pregnancy (she declared 3 glasses of wine every day). At the age of 6 months, the child showed a moderate neurodevelopmental delay. Conclusion: This case shows that FAD should be considered in neonates with rare neurological diseases as porencephaly. In neonates and infants born to a mother who did not report alcohol use, EtG measure in hairs can significantly improve diagnosis of FASD, so allowing to exclude genetic diseases associated with similar clinical findings.

Comparison of self‐reported alcohol consumption and ethyl glucuronide in hair in a sample of 60+ year ‐olds treated for DSM‐5 alcohol use disorder

“…So far, hEtG has been used to examine alcohol consumption or validate self‐reported consumption among university and college students, 33–35 in teenage populations (aged 14–15 years) 36 and in a population study of young men 37 . Also, hEtG has been applied in child custody cases, 38 as well as in examinations of prenatal alcohol exposure 39–43 . Further, hEtG has been used in somatic treatment settings 44–46 and is widely utilised in forensic 47,48 and criminal justice 49–52 settings.…”

“… 37 Also, hEtG has been applied in child custody cases, 38 as well as in examinations of prenatal alcohol exposure. 39 , 40 , 41 , 42 , 43 Further, hEtG has been used in somatic treatment settings 44 , 45 , 46 and is widely utilised in forensic 47 , 48 and criminal justice 49 , 50 , 51 , 52 settings.…”