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Early lethal syndrome involving multiple joint contractures, camptodactyly, facial anomalies, and pulmonary hypoplasia.

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Fetal Akinesia/Hypokinesia Sequence; Fetal Akinesia Deformation Syndrome (FADS).

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First described by S.D.J. Pena and W.H.K. Shokeir in 1974.

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Rare; more than 30 cases reported. First identified in 1974. F = M.

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Autosomal recessive in more than half the cases. Etiology heterogeneous. Risk of recurrence has been estimated between 10 and 15% unless there is maternal myasthenia gravis (several cases), in which case recurrence is high. Thought to represent a lesser degree of clinical expressivity of the same mutation.

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The clinical phenotype is probably caused by decreased in utero movement, whatever the cause (muscular, spinal, or cerebral). This results in ankylosis of multiple joints, absence of breathing in association with pulmonary hypoplasia, absence of swallowing resulting in polyhydramnios, and absence of facial muscle movements leading to craniofacial anomalies.

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Clinical based on the multiple features of disease. Approximately 30% are stillborn and those that reach term are small for dates. Antenatal ultrasonography shows lack of fetal movement and polyhydramnios. Confirmation is with muscle histology or at postmortem examination.

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Neurological: muscle atrophy, generalized hypotonia, and hyporeflexia/areflexia. Musculoskeletal: arthrogryposis of multiple joints, multiple ankyloses, camptodactyly, rocker-bottom feet, short neck. Craniofacial: expressionless faces, hypertelorism, micrognathia, cleft palate. Pulmonary: hypoplasia. Cardiac: cardiac hypoplasia, arrhythmias, congenital defects. Endocrine: adrenal hypoplasia, failure to thrive. Death usually occurs in the neonatal period as a consequence of lung hypoplasia and there have been no survivors after 1 year in babies.

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It is unlikely that anesthesia will be required in these babies. Full assessment of the severity of the syndrome is needed. It is likely that the babies will be ventilated initially.

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Micrognathia may make direct laryngoscopy difficult. May have significant pulmonary hypoplasia.

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Adrenal hypoplasia may require steroid supplementation.

Jones KL: Smith's Recognisable Patterns of Human Malformations. 5th ed. WB Saunders, Philadelphia 1997, p 174.
Katzenstein M, Goodman R: Preand postnatal findings in Pena-Shokeir 1 syndrome: Case report and review of the literature. J Craniofac Genet Dev Biol 8(2):11, 1988.
Takada E, Koyama N, Ogawa Y et al: Neuropathology of infant with Pena-Shokeir 1 syndrome. Pediatr Neurol 10(3):241, 1994.

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