Search

Althoughmuchhasbeenlearnedin 30 years, substantial challenges re-mainindiagnosingandpreventingthisdisorder.Ourgoalistosummarizewhathasrecentlybeenreportedwithrespectto fetal alcohol terminology, identifica-tion, effects, prevalence, and preven-tionofexposure.Wewillemphasizehowfetal alcohol exposure is routinely un-deridentified and what is known aboutwhoisatrisk.Withthisknowledge,phy-sicians should be better able to identifyat-risk pregnancies and alcohol-affectedindividualsandaddressfetalal-cohol exposure in the clinical setting.

Background: Exposure to violence in childhood has been associated with lower school grades. However, the association between violence exposure and performance on standardized tests (such as IQ or academic achievement) in children is unknown. It is also not known whether violence exposure itself or subsequent symptoms of trauma are primarily responsible for negative outcomes. Objective: To examine the relationship between violence exposure and trauma-related distress and standardized test performance among early school-aged urban children, controlling for important potential confounders. Design: A total of 299 urban first-grade children and their caregivers were evaluated using self-report, interview, and standardized tests. Main Outcome Measures: The child’s IQ (Wechsler Preschool and Primary Scale of Intelligence–Revised) and reading ability (Test of Early Reading Ability, second edition) were the outcomes of interest. Results: After controlling for confounders (child’s gender, caregiver’s IQ, home environment, socioeconomic status, and prenatal exposure to substance abuse) violence exposure was related to the child’s IQ (P=.01) and reading ability (P=.045). Trauma-related distress accounted for additional variance in reading ability (P=.01). Using the derived regression equation to estimate effect sizes, a child experiencing both violence exposure and trauma-related distress at or above the 90th percentile would be expected to have a 7.5-point (SD, 0.5) decrement in IQ and a 9.8point (SD, 0.66) decrement in reading achievement. Conclusion: In this study, exposure to violence and trauma-related distress in young children were associated with substantial decrements in IQ and reading achievement.

Background: Birth weight (BW)/length ratios, ponderal indexes, placental weights, and BW/placental weight ratios have been correlated with perinatal morbidity and mortality. Methods: Cross-sectional survey of live-born, structurally normal, singleton neonates delivered at a tertiary care center in Detroit, Mich, from 1984 through 1991. Subjects were included if dating based on menstrual dates and ultrasonographic estimations agreed with Ballard examination to within 2 weeks. Results: Of 33 138 neonates, 26 983 (81.4%) were black. While all indexes significantly increased with advancing gestational age, only placental weights (without prior draining of blood, blotting the placenta dry, or trimming the membranes or cord) and BW/length ratios significantly increased beyond 40 weeks' gestation. Multivariate analysis of variance revealed that placental weights, BW/placenta ratios, and BW/length ratios were significantly related to gender and ethnicity, but ponderal index was not. Placental weights were larger, and BW/placenta ratios were smaller than studies that trimmed the placentas before weighing. Conclusions: All indexes were gestational age dependent, but ponderal index and BW/placenta ratios do not increase beyond 40 weeks' gestation. Except for ponderal index, interpretation of these indexes should be specific for ethnicity, gender, and manner of placental preparation. (Arch Pediatr Adolesc Med. 1994;148:508-512)

To the Editor. — The article by Kramer et al1reaffirms the poor quality of estimates of gestational age afforded by dating of the last normal menstrual period (LNMP). The authors express surprise that the magnitude of the bias toward the mean of such estimates increases the further the LNMP estimate differs from the mean of the estimates. This should not come as a surprise. In fact, it can be anticipated from probabilistic considerations without collecting any data. To illustrate why bias toward the mean increasing as distance from the mean increases could be anticipated, consider the following hypothetical simplification. Suppose that all gestational ages at delivery are 39 weeks, but that the LNMP estimate has a distribution ranging from 36 to 42 weeks. Then consider a plot, like the figure on page 3307 of the article by Kramer et al, of the difference between the LNMP estimate

A relationship between perinatal risk, ie, obstetric complications, and cerebral palsy has been documented for more than 120 years. 1 Interest in this association increased in the mid-20th century and was one of the factors that produced the Collaborative Project, for which data were collected at 12 teaching hospitals from 1959 to 1966, ie, about 20 years ago. The resulting data base continues to yield interesting and useful findings, such as those from the study in this issue ofThe Journalby Nelson and Ellenberg. 2 Of the numerous observations reported by these authors, two seem to be key findings. Among infants of normal birth weight (>2,500 g), there was a relatively low risk for cerebral palsy, regardless of obstetric complications, as long as the five-minute Apgar score was normal (≥7). Similarly, the risk for cerebral palsy was not particularly high with a very low five-minute Apgar score (≤3)