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Medical evaluation of internationally adopted children.
N Engl J Med. 1991 Aug 15; 325(7):479-85.NEJM

Abstract

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.

Authors+Show Affiliations

Department of Pediatrics, School of Public Health, University of Minnesota, Minneapolis 55455.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

1649404

Citation

Hostetter, M K., et al. "Medical Evaluation of Internationally Adopted Children." The New England Journal of Medicine, vol. 325, no. 7, 1991, pp. 479-85.
Hostetter MK, Iverson S, Thomas W, et al. Medical evaluation of internationally adopted children. N Engl J Med. 1991;325(7):479-85.
Hostetter, M. K., Iverson, S., Thomas, W., McKenzie, D., Dole, K., & Johnson, D. E. (1991). Medical evaluation of internationally adopted children. The New England Journal of Medicine, 325(7), 479-85.
Hostetter MK, et al. Medical Evaluation of Internationally Adopted Children. N Engl J Med. 1991 Aug 15;325(7):479-85. PubMed PMID: 1649404.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Medical evaluation of internationally adopted children. AU - Hostetter,M K, AU - Iverson,S, AU - Thomas,W, AU - McKenzie,D, AU - Dole,K, AU - Johnson,D E, PY - 1991/8/15/pubmed PY - 1991/8/15/medline PY - 1991/8/15/entrez SP - 479 EP - 85 JF - The New England journal of medicine JO - N Engl J Med VL - 325 IS - 7 N2 - 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. SN - 0028-4793 UR - https://www.unboundmedicine.com/medline/citation/1649404/Medical_evaluation_of_internationally_adopted_children_ L2 - https://www.nejm.org/doi/10.1056/NEJM199108153250706?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -