The nurse is assessing a 12-hour-old infant with a maternal history of frequent alcohol consumption during pregnancy. Which finding should the nurse report that is most suggestive of fetal alcohol syndrome (FAS)?

• A. An extra digit on the left hand.
• B. Corneal clouding.
• C. Flat nasal bridge.
• D. Asymmetrical bulging fontanels.

Answer: (C)

Fetal alcohol syndrome manifests with facial features and growth or CNS abnormalities caused by alcohol exposure in utero. A flattened midface and, in particular, a flat nasal bridge are classic facial dysmorphisms seen with FAS, reflecting disruption of midfacial development. In a newborn whose mother drank alcohol during pregnancy, this flattened nasal bridge is the most telling sign among the options because it directly reflects the characteristic facial structure changes associated with FAS.

The other findings don’t align with FAS. An extra digit is not a typical feature of FAS and points to other conditions like polydactyly. Corneal clouding isn’t a hallmark of FAS and would suggest other ocular or systemic issues. A bulging fontanelle that’s asymmetrical suggests increased intracranial pressure or a cranial issue rather than FAS. If FAS is suspected, look for other signs as well, such as a smooth philtrum, a thin upper lip, small palpebral fissures, growth restriction, and potential CNS involvement, but the flat nasal bridge remains a key, early indicator in the newborn context.