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Medical evaluation of internationally adopted children
M K Hostetter1, S Iverson, W Thomas
1Department of Pediatrics, School of Public Health, University of Minnesota, Minneapolis 55455.
Insights
Medical screening tests are crucial for internationally adopted children, identifying significant health conditions in over half of those evaluated. These tests, particularly for infectious diseases like hepatitis B and intestinal parasites, are vital for early diagnosis and treatment.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Children adopted internationally often present with undiagnosed medical conditions.
- There is a lack of standardized medical evaluation guidelines for this population.
- Early detection of health issues is critical for the well-being of adopted children.
Purpose of the Study:
- To establish the prevalence of medical conditions in internationally adopted children.
- To determine the effectiveness of screening tests in identifying health issues.
- To advocate for routine medical screening protocols for adopted children.
Main Methods:
- Evaluation of 293 internationally adopted children from 15 countries.
- Comprehensive assessment including medical history, physical examination, and targeted screening tests.
- Screening included tests for hepatitis B virus (HBV), HIV-1, tuberculosis, intestinal parasites, syphilis, cytomegalovirus, renal disease, and anemia.
Main Results:
- Over half (57%) of the children had at least one significant medical condition, primarily infectious diseases (73%).
- Screening tests were more effective (81%) in diagnosis than history or physical exam alone.
- Hepatitis B virus (HBV) infection was found in 5% of children, associated with early arrival, Asian origin, and prior blood transfusions.
- Tuberculin reactivity was noted in 3%, with active tuberculosis in some cases, linked to older age and lower weight.
- Intestinal parasites were prevalent (14%), with non-Korean adoptees significantly more likely to be affected.
Conclusions:
- Routine, directed screening tests are essential for all internationally adopted children.
- Screening effectively identifies a high prevalence of medical conditions, especially infectious diseases.
- Established guidelines for medical evaluation are needed to ensure comprehensive care for this vulnerable population.
Background:
Despite many reports of medical illness in children adopted from abroad, there are currently no accepted guidelines for medical evaluation of this population.
Methods:
Two hundred ninety-three children adopted from 15 countries (mean age, 14.0 months; 55 percent girls) were evaluated by history taking, physical examination, and screening tests for hepatitis B virus (HBV), human immunodeficiency virus type 1, tuberculin reactivity, intestinal parasites, syphilis, excretion of cytomegalovirus, renal disease, and anemia. All but four were seen within one month of their arrival in the United States.
Results:
Fifty-seven percent of the children (168 of 293) were found to have at least one important medical condition. Eighty-one percent of the diagnoses were established by screening test, rather than by history taking or physical examination. Infectious diseases made up the majority of the medical conditions (73 percent). Serologic testing for hepatitis B surface antigen was positive in 5 percent of the children. Characteristics associated with the acquisition of HBV infection included arrival within the first three years of the study (P = 0.017), Asian origin (P = 0.011), and receipt of a blood transfusion abroad (P = 0.008). Ten children (3 percent) had positive Mantoux skin tests, and four of these had active pulmonary tuberculosis. Tuberculin reactivity was significantly associated with older age (P less than 0.001) and lower weight (P = 0.037). Intestinal parasites were isolated from 14 percent of the international adoptees. Non-Korean adoptees were 16 times more likely to be harboring at least one intestinal parasite than were Korean adoptees (P = 0.005).
Conclusions:
Directed screening tests should be a routine component of the medical evaluation of all children adopted from abroad, regardless of age, sex, or country of origin.