title: Importance of a multidisciplinary approach and monitoring in fetal warfarin syndrome.
abstract: Warfarin is a synthetic oral anticoagulant that crosses the placenta and can lead to a number of congenital abnormalities known as fetal warfarin syndrome. Our aim is to report on the follow-up from birth to age 8 years of a patient with fetal warfarin syndrome. He presented significant respiratory dysfunction, as well as dental and speech and language complications. The patient was the second child of a mother who took warfarin during pregnancy due to a metallic heart valve. The patient had respiratory dysfunction at birth. On physical examination, he had a hypoplastic nose, pectus excavatum, and clubbing of the fingers. Nasal fibrobronchoscopy showed upper airway obstruction due to narrowing of the nasal cavities. He underwent surgical correction with Max Pereira graft, zetaplasty, and osteotomies for the piriform aperture. At dental evaluation, he had caries and delayed eruption of the upper incisors. Speech and language assessment revealed high palate, mouth breathing, little nasal patency, and shortened upper lip. Auditory long latency and cognitive-related potential to auditory stimuli demonstrated functional changes in the cortical auditory pathways. We believe that the frequency of certain findings observed in our patient may be higher in fetal warfarin syndrome than is appreciated, since a significant number result in abortions, stillbirths, or children evaluated in the first year of life without a follow-up. Thus, a multidisciplinary approach and long-term monitoring of these patients may be necessary.
authors.affiliation: Graduate Program in Pathology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), RS, Brazil.|Graduation in Nursing, UFCSPA, RS, Brazil.
authors.forename: Daniélle B
authors.initials: DB
authors.lastname: Silveira
authors.affiliation: Graduation in Nursing, UFCSPA, RS, Brazil.
authors.forename: Ernani B
authors.initials: EB
authors.lastname: da Rosa
authors.affiliation: Clinical Genetics, UFCSPA and Complexo Hospitalar Santa Casa de Porto Alegre (CHSCPA), RS, Brazil.
authors.forename: Vinicius F
authors.initials: VF
authors.lastname: de Mattos
authors.affiliation: Graduate Program in Pathology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), RS, Brazil.
authors.forename: Thayse B
authors.initials: TB
authors.lastname: Goetze
authors.affiliation: Speech Language Pathology, Universidade Federal do Rio Grande do Sul (UFRGS), RS, Brazil.
authors.forename: Pricila
authors.initials: P
authors.lastname: Sleifer
authors.affiliation: Graduate Program in Pathology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), RS, Brazil.
authors.forename: Fernanda D
authors.initials: FD
authors.lastname: Santa Maria
authors.affiliation: Graduate Program in Pathology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), RS, Brazil.
authors.forename: Rosana C M
authors.initials: RC
authors.lastname: Rosa
authors.affiliation: Graduate Program in Pathology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), RS, Brazil.|Clinical Genetics, UFCSPA and Complexo Hospitalar Santa Casa de Porto Alegre (CHSCPA), RS, Brazil.|Clinical Genetics, Hospital Materno Infantil Presidente Vargas (HMIPV), RS, Brazil.
authors.forename: Rafael F M
authors.initials: RF
authors.lastname: Rosa
authors.affiliation: Graduate Program in Pathology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), RS, Brazil.|Clinical Genetics, UFCSPA and Complexo Hospitalar Santa Casa de Porto Alegre (CHSCPA), RS, Brazil.
authors.forename: Paulo R G
authors.initials: PR
authors.lastname: Zen
mesh_terms: D000014:Abnormalities, Drug-Induced / Q000235:genetics / Q000473:pathology* / Q000601:surgery; D001308:Auditory Perceptual Disorders / Q000139:chemically induced / Q000235:genetics / Q000473:pathology* / Q000601:surgery; D002648:Child; D005260:Female; D005333:Fetus; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009035:Mothers; D009295:Nasal Bone / Q000002:abnormalities* / Q000473:pathology / Q000601:surgery; D015508:Nasal Obstruction / Q000139:chemically induced / Q000235:genetics / Q000473:pathology* / Q000601:surgery; D010027:Osteotomy; D011247:Pregnancy; D011297:Prenatal Exposure Delayed Effects / Q000139:chemically induced / Q000235:genetics / Q000473:pathology* / Q000601:surgery; D014071:Tooth Abnormalities / Q000139:chemically induced / Q000235:genetics / Q000473:pathology* / Q000601:surgery; D014859:Warfarin / Q000009:adverse effects*
chemical_list: D014859:Warfarin
keywords: dental anomalies; fetal warfarin syndrome; multidisciplinary approach; nasal hypoplasia; respiratory dysfunction; speech language pathology