title: Fetal alcohol spectrum disorders in children residing in Russian orphanages: a phenotypic survey.
abstract: BACKGROUND
  Alcohol use in Russia is among the highest in the world. Over 600,000 children reside in institutional care in Russia, most of them in baby homes and orphanages. The actual prevalence of fetal alcohol spectrum disorders (FASD) among these children is unknown. Therefore, we performed a systematic survey of phenotypic features associated with prenatal alcohol exposure among institutionalized Russian children and related these findings to their growth, development, medical, and social histories.
  
  
  METHODS
  Phenotypic screening was conducted of all 234 baby home residents in the Murmansk region of Russia (mean age 21+12.6 months). Phenotypic expression scores were devised based on facial dysmorphology and other readily observable physical findings. Growth measurements from birth, time of placement in the baby home, and at present were analyzed. In addition, the charts of 64% of the children were randomly selected for retrospective review. Information collected included maternal, medical, developmental, and social histories.
  
  
  RESULTS
  Thirteen percent of children had facial phenotype scores highly compatible with prenatal alcohol exposure and 45% had intermediate facial phenotype scores. These scores correlated with maternal gravidity and age. At least 40% of mothers in whom history was available ingested alcohol during pregnancy; some also used illicit drugs and tobacco. Z scores for growth measurements corresponded to phenotypic score, as did the degree of developmental delay. Children with no or mild delay had significantly lower phenotypic scores than those with moderate or severe delay (p = 0.04); more than 70% of children with high phenotypic scores were moderately or severely delayed.
  
  
  CONCLUSIONS
  More than half of residents of the baby homes in Murmansk, Russia, have intermediate (45%) or high (13%) phenotypic expression scores suggesting prenatal exposure to alcohol. Despite good physical care, stable daily routine, availability of well-trained specialists, and access to medical care, these vulnerable children show significant growth and developmental delays compared with their institutionalized peers.
authors.affiliation: International Adoption Clinic, Tufts-New England Medical Center, Boston, Massachusetts 02111, USA. lmiller1@tufts-nemc.org
authors.forename: Laurie C
authors.initials: LC
authors.lastname: Miller
authors.forename: Wilma
authors.initials: W
authors.lastname: Chan
authors.forename: Aina
authors.initials: A
authors.lastname: Litvinova
authors.forename: Arkady
authors.initials: A
authors.lastname: Rubin
authors.forename: Kathleen
authors.initials: K
authors.lastname: Comfort
authors.forename: Linda
authors.initials: L
authors.lastname: Tirella
authors.forename: Sharon
authors.initials: S
authors.lastname: Cermak
authors.forename: Barbara
authors.initials: B
authors.lastname: Morse
authors.forename: Igor
authors.initials: I
authors.lastname: Kovalev
mesh_terms: D000886:Anthropometry; D002675:Child, Preschool; D002971:Cleft Lip / Q000139:chemically induced / Q000453:epidemiology; D002972:Cleft Palate / Q000139:chemically induced / Q000453:epidemiology; D005145:Face / Q000002:abnormalities / Q000473:pathology; D005260:Female; D063647:Fetal Alcohol Spectrum Disorders / Q000453:epidemiology* / Q000473:pathology*; D006128:Growth / Q000502:physiology; D006330:Heart Defects, Congenital / Q000139:chemically induced / Q000453:epidemiology; D006801:Humans; D007223:Infant; D008297:Male; D019372:Orphanages; D010641:Phenotype; D011247:Pregnancy; D012426:Russia / Q000453:epidemiology