Type of Paper: Original article; Medical Chart Review
Purpose: To compare the pre-adoptive medical records to the medical evaluations soon after arrival into the U. S. in children adopted from Eastern Europe.
- Pre-adoption records from the birth country: Some, but not all the records, included gestational age, birth weight, failure to thrive, anemia, rickets, and vitamin supplementation.
- Post-adoption medical evaluations at the International Adoption Clinics:
- Physical growth: standard anthropometry [height, weight, head circumference (OFC)]. Z scores for height and weight were calculated using the World Health Organization standards and for OFC using data from American children because the World Health Organization did not have published standards for OFC at the time.
- Anemia: complete blood cell count
- Intestinal Parasites: stool examination for ova and parasites?
Participants: 56 children adopted from Eastern Europe and the former Soviet Union who were seen in 2 international adoption clinics. Pre-adoptive medical records from the birth country were available for 47 of the children. Children were between 2. 5 months and 9 years old at arrival into the US (median age was 26 months).
Methods: Chart review of (1) pre-adoptive medical records from the birth countries and (2) medical evaluations that had been completed soon after arrival in the U. S.
- Pre-adoption records:
- Gestational age: known for 34 children. 11 (32%) were born prior to 36 weeks. The range was 28 to 40 weeks gestation.
- Birth weight: known for 38 children. 11 (29%) were small for gestational age.
- Nutritional diagnoses: 9 children were diagnosed with failure to thrive, 7 with anemia, and 6 with rickets. However, for the reports that included hematocrits (an indicator of anemia), all were within normal limits.
- Each child had multiple diagnoses recorded with little or no documentation of physical or laboratory findings to support the diagnoses.
- Vitamins were often given. However, dates, doses, and routes of administration were not reported.
- Evaluations at the international adoption clinics:
- Physical growth:
- Average z scores were below the mean (i.e., z score of 0). Average z scores were:
- Height for age (HAZ): -1. 41 (range: -4. 52 to 1. 79)
- Weight for age (WAZ): -1. 05 (range: -3. 54 to 2. 23)
- Head circumference for age (OFCZ): -1. 25 (range: -3. 7 to 0. 62)
- The following number of children were below -1 z score for growth (-1 z score is equivalent to approximately the 16th percentile):
- HAZ: 68%
- WAZ: 44%
- OFCZ: 43%
- The extent of linear growth lag (height delay) was correlated with the duration in the orphanage. There was one month of growth lag for each five months spent in orphanage care.
- Intestinal parasites were found in half of the children (51%).
Conclusions & Clinical Implications: The authors not that there were often discrepancy between the pre-adoptive evaluations and the post-arrival medical evaluations in the U. S. According to the pre-adoption medical records, almost one-third (32%) were born premature and over one-quarter (29%) were born small for gestational age. Although this paper did not address the nutritional risk, children born early and/or small for gestational age may be at a greater risk for malnutrition and need special nutritional considerations. According to the post-adoption medical records, there were growth delays in height, weight, and head circumference at arrival. Linear growth (i.e., height) delay was associated with the length of time spent in institutions. Also, intestinal parasites were common at the time of arrival, and although not discussed in this paper, intestinal parasites may increase the risk for both macronutrient (e. g. , physical growth) and micronutrient (vitamins and minerals) malnutrition.
Limitations of the Nutritional Results: The authors note that growth delays may have been underestimated because birth dates were unknown and estimated in some children. According to the pre-adoption medical records, none of the children had abnormal hematocrits, and indicator of anemia, prior to adoption. However, the rate of anemia post-arrival was not reported.
Reference: Albers LH, Johnson DE, Hostetter MK, Iverson S, Miller LC. Health of Children Adopted From the Former Soviet Union and Eastern Europe. JAMA: The Journal of the American Medical Association. 1997; 278 (11): 922-924. http://www.ncbi.nlm.nih.gov/pubmed/9302245