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In some people, the condition is likely caused by the interaction of multiple genetic and environmental factors. Some possible genetic and environmental influences have been identified and are being studied.

The disruption to fetal development that causes VACTERL association likely occurs early in development, resulting in birth defects that affect multiple body systems.

A few affected individuals have family members with one or two features, but not enough signs to be diagnosed with the condition.

Multiple genetic and environmental factors likely play a part in determining the risk of developing this condition and how severe the condition will be in an individual.

Am J Med Genet A. Eur J Med Genet. In early life these rarely cause any difficulties, although the presence of these defects on a chest X-ray may alert the physician to other defects associated with VACTERL.

Later in life these spinal column abnormalities may put the child at risk for developing scoliosis, or curvature of the spine.

These anomalies are usually noted at birth and often require surgery in the first days of life. Sometimes babies will require several surgeries to fully reconstruct the intestine and anal canal.

Esophageal atresia with tracheoesophageal fistula TE fistula is seen in about 70 percent of patients with VACTERL association, although it can frequently occur as an isolated defect.

Fifteen percent to 33 percent of patients with TE fistulas will also have congenital heart disease.

However these babies usually have uncomplicated heart defects, like a VSD, which may not require any surgery. In addition, up to 35 percent of patients with VACTERL association have a single umbilical artery there are usually two which can often be associated with kidney or urologic problems.

These defects can be severe with incomplete formation of one or both kidneys or urologic abnormalities such as obstruction of outflow of urine from the kidneys or severe reflux backflow of urine into the kidneys from the bladder.

These problems can cause kidney failure early in life and may require kidney transplant. Many of these problems can be corrected surgically before any damage can occur.

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VATER syndrome is a set of birth defects that often occur together. It is not a disease per se but is rather a condition classified as a "non-random association.

A child diagnosed with VATER syndrome will not necessarily have all of these defects but must have at least three for the condition to be diagnosed.

Since VATER syndrome involves a collection of several different congenital malformations, the signs and symptoms can vary from person to person.

VATER can cause severe disability but is not associated with brain defects or intellectual disability. As such, children who grow to adulthood will typically have normal intelligence and can live independently.

Scientists believe that a genetic defect is involved which appears to disrupt fetal development very early in the pregnancy. It is an extremely rare condition, affecting only around one in 10, to 40, children.

VATER syndrome does not involve a known disease process, so there is not one medical test that can definitively diagnose it or rule it out.

A diagnosis is made based on a physical exam and the results of specialized organ-specific tests such as X-rays to identify vertebral anomalies or renal ultrasound to detect kidney malformations.

In some cases, a diagnosis can be made while the child is still in the womb using an imaging tool called an obstetric sonogram.

In order to be diagnosed with VATER, a child must have abnormalities in at least three of the characteristic organ systems. Because VATER syndrome does not impact intellectual function, a child with significant cognitive challenges would not be diagnosed with the syndrome.

Instead, other conditions would be explored in which intellectual disabilities are characteristic features. While some will continue to have serious medical concerns throughout their lives, others will become healthy, happy adults with few, if any, medical concerns.

If the letters played touches any adjacent words, it must also form a word in order to be playable. Letters cannot be moved or shifted after they are already played.

Blank tiles can be used in place of any letter. You can use a turn to exchange any amount of your letters. You can challenge a word before the next turn starts.

If the challenge is lost by the player, they the losing party must take their tiles back and they lose their next turn.

The game is over when all letters are gone from the letter bag and one of the players has no more tiles. The game also ends if there are no possible plays left.

Scrabble Help Here are a few tips to win every game without the use of a scrabble cheat Plan ahead and use your tiles wisely.

There is a limited number of each tile in the game. Be sure to block your opponent whenever possible.

In order to keep the highest score, you need to play defense. If you see a possible word and have a chance to block the next player from getting it, take that opportunity!

Try to find letters that usually go together like Br,Th, Sh, Ch, etc. Adding common prefixes or suffixes where they are valid is also an awesome tactic.

Practice, practice, practice!. If all else fails, ask for help You can always our scrabble word generator if you get stuck Here is a list of Scrabble Help.

Scrabble Word Maker What is a scrabble word generator used for? High Value Words. Scrabble Letter Values A is 1 points. B is 3 points.

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