CANADIAN PALPEBRAL FISSURE LENGTH GROWTH CHARTS REFLECT A GOOD FIT FOR TWO SCHOOL AND FASD CLINIC-BASED U.S. POPULATIONS

Main Article Content

Susan J Astley

Keywords

Fetal alcohol syndrome (FAS), fetal alcohol spectrum disorders (FASD), FASD 4-Digit Diagnostic Code, palpebral fissure length

Abstract

Background


Short palpebral fissure lengths (PFL) are one of three facial features that define the unique facial phenotype of fetal alcohol syndrome (FAS). Published PFL growth charts vary greatly in both rate and magnitude of growth, placing their accuracy and validity in question. New PFL growth charts were recently published to reflect a racial/ethnic cross section of Canadian girls and boys 6-16 years of age. PFLs were measured from digital facial photographs using the FAS Facial Photographic Analysis Software.


 


Objectives


Assess the goodness of fit of two U.S. populations (healthy children and children with prenatal alcohol exposure) when plotted on the Canadian, Hall, and other published PFL charts.


 


Methods


The PFLs of 106 healthy children and 822 children with prenatal alcohol exposure fromWashington State were measured from digital facial photographs using the FAS Facial Photographic Analysis Software. Goodness of fit was assessed graphically and by computation of the mean PFL z-score.


 


Results


Our predominantly Caucasian, healthy group of children scattered along the mean growth curve on the Canadian charts (mean PFL z-score +0.2), and fell 1.6 SDs below the mean on the Hall chart (mean PFL z-score -1.6). The mean PFL z-score for the children with FAS was 2.4 SDs below the mean on the Canadian charts and 3.9 SDs below the mean on the Hall chart. African Americans were not a good fit.


 


Conclusion


The Canadian PFL charts were a good fit for our predominantly Caucasian populations of healthy U.S. school-aged children. Children with FAS continued to present with PFLs 2 or more SDs below the mean when plotted on the Canadian PFL charts, supporting the FAS PFL diagnostic criteria used by the FASD 4-Digit Diagnostic Code. Use of PFL charts normed for African Americans is recommended. Updated PFL charts for 0-6 years of age are vital to prevent an artificial over-estimation of short PFLs in this age group.

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References

1. Barretto RL, Mathog RH. Orbital measurement in black and white populations. Laryngoscope 1999:109;1051-1054.
2. Chouke KS. The epicanthus or mongolian fold in Caucasian children. American Journal of Physical Anthroplogy 1929;13(2):255-279.
3. Farkas LG. (ed). Anthropometry of the Head and Face. 2nd ed. New York: Raven Press, 1994.
4. Fuchs M, Iosub S, Bingol N, Gromisch DS., Palpebral fissure size revisited. J Pediatrics 1980;96:77-78.
5. Hall JG, Froster-Iskenius UG, Allanson JE. Handbook of Normal Physical Measurements. New York: Oxford University Press, 1989.
6. Iosub S, Fuchs M, Bingol N, Stone R, Gromisch D, Wasserman E. Palpebral fissure length in black and Hispanic children: Correlation with head circumference. Pediatrics 1985;75(2);318-320.
7. Jones KL, Hanson JW, Smith DW. Palpebral fissure size in newborn infants. Pediatr 1978;92(5):787
8. Strömland K, Chen YH, Norberg T, Wennerstrom K, Michael G. Reference values of facial features in Scandinavian children measured with a range-camera technique. Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery 1999;33:59-6.
9. Thomas IT, Gaitantzis YA, Frias JL. Palpebral fissure length from 29 weeks gestation to 14 years. Journal of Pediatrics 1987;III(2):267-2688.
10. Astley SJ. Diagnostic Guide for Fetal Alcohol Spectrum Disorders: The 4-Digit Diagnostic Code. 3rd ed. Seattle WA: University of Washington Publication Services; 2004.
11. Chudley AE, Conry J, Cook JL, Loock C. Rosales T, LeBlanc N. Fetal alcohol spectrum disorder. Canadian guidelines for diagnosis. CMAJ 2005;172:S1-S21.
12. Clarren SK, Chudley AE, Wong L, Friesen J, Brant R. Normal distribution of palpebral fissure lengths in Canadian school age children. Can J Clin Pharmacology 2010;17(1):e67-e78.
13. Fox SA. The Palpebral Fissure. American Journal of Ophthalmology 1966;62(1):73-78.
14. Farkas LG. Anthropometry of the Head and Face in Medicine. New York: Elsevier, 1981.
15. Laestadius ND, Aase JM, Smith DW. Normal innercanthal and outer orbital dimensions. Journal of Pediatrics 1969; 74: 465-8.
16. Astley SJ, Olson HC, Kerns K, et al. Neuropsychological and behavioral outcomes from a comprehensive magnetic resonance study of children with fetal alcohol spectrum disorders. Canadian Journal of Clinical Pharmacology 2009;16(1):e178-e201.
17. Astley SJ, Aylward EH, Olson HC, et al. Magnetic resonance imaging outcomes from a comprehensive magnetic resonance study of children with fetal alcohol spectrum disorders. Alcohol Clin Exp Res 2009;33(10):1-19.
18. Astley SJ, Aylward EH, Olson HC, et al. Functional magnetic resonance imaging outcomes from a comprehensive magnetic resonance study of children with fetal alcohol spectrum disorders. Journal of Neurodevelopmental Disorders 2009;1(1):61-80.
19. Astley SJ, Richards T, Aylward EH, et al. Magnetic resonance spectroscopy outcomes from a comprehensive magnetic resonance study of children with fetal alcohol spectrum disorders. Magn Reson Imaging 2009;27:760-778.
20. Astley SJ. Profile of the first 1,400 patients receiving diagnostic evaluations for fetal alcohol spectrum disorder at the Washington State Fetal Alcohol Syndrome Diagnostic & Prevention Network. Can J Clin Pharmacol Vol 17(1) Winter 2010;e132-e164: March 26, 2010.
21. Astley SJ. Fetal Alcohol Syndrome Facial Photograph Analysis Software. version 1.0, Seattle: University of Washington; 2003.
22. Adobe Photoshop CS2, Version 9.02. 2008.
23. SPSS. Statistical Package for the Social Sciences. Chicago: IBM Company; 2008.
24. Hirschfeld S, Songco D, Kramer BS, Guttmacher AE. National Children’s Study: Update in 2010. Mount Sinai Journal of Medicine 72011;8:119-125.