A 4 week old has short palpebral fissures, hypoplastic philtrum and low nasal bridge with current symptoms of a poor suck and jitteriness. Which of the following in-utero exposures is most likely?

A 4 week old has short palpebral fissures, hypoplastic philtrum and low nasal bridge with current symptoms of a poor suck and jitteriness. Which of the following in-utero exposures is most likely?

• A. Cocaine
• B. Alcohol
• C. Amphetamines
• D. Barbiturates

Answer: (B)

In-utero alcohol exposure causing fetal alcohol syndrome is suggested by the facial pattern described—short palpebral fissures, a hypoplastic (flattened) philtrum, and a low nasal bridge. Ethanol disrupts facial development during weeks 3–8 of gestation, particularly affecting neural crest–driven formation of midfacial structures, leading to these characteristic features. The newborn’s poor suck and jitteriness reflect CNS involvement or withdrawal that can accompany fetal alcohol exposure. Among the options, alcohol is the exposure most consistently linked to this specific craniofacial pattern. Cocaine, amphetamines, and barbiturates can cause irritability, poor feeding, or withdrawal symptoms, but they do not produce the distinct facial dysmorphology seen with fetal alcohol syndrome.

In-utero alcohol exposure causing fetal alcohol syndrome is suggested by the facial pattern described—short palpebral fissures, a hypoplastic (flattened) philtrum, and a low nasal bridge. Ethanol disrupts facial development during weeks 3–8 of gestation, particularly affecting neural crest–driven formation of midfacial structures, leading to these characteristic features. The newborn’s poor suck and jitteriness reflect CNS involvement or withdrawal that can accompany fetal alcohol exposure. Among the options, alcohol is the exposure most consistently linked to this specific craniofacial pattern. Cocaine, amphetamines, and barbiturates can cause irritability, poor feeding, or withdrawal symptoms, but they do not produce the distinct facial dysmorphology seen with fetal alcohol syndrome.