Laboratory Testing in Internationally Adopted Children
Since the 1980s more than 10,000 internationally adopted children have entered the United States and the popularity of these adoptions is increasing. There are multiple factors to consider in assessing the probable health of the child. The first is the country of origin, which has shifted from predominantly Korea to more commonly China, Russia or eastern Europe. The pre-adoption environment should also be considered and this has shifted from foster care in families to institutions. The increase in adoption of whole families, including older children, has resulted in the adoption of some children who have spent an extended period of time in institutions. Finally, the increase in the number of agencies handling adoptions has added to the confusion. Although all internationally adopted children have been medically screened in their country of origin, laboratory results reported in this screen should not be considered reliable. Laboratory testing in the United States provides objective, independent data as part of the health assessment.
IgG antibody results from the child need to be interpreted with consideration for the age of the child, remembering that maternal transplacental antibodies can persist for up to 18 months. However, the testing may be helpful in determining the health status of the biological mother.
1. HBsAg and antibodies to Hepatitis B surface and core antigens: Be sure to review both the IgM and total antibody to the core antigen independently. The full testing should be done even on children who have been vaccinated. Testing for HBsAg and antibody to HBsAg does not identify children in the “window” period. They can be identified by the presence of antibodies to core. If the HBsAg is positive, test for HBe antigen, delta virus and transaminases.
2. Antibodies to Hepatitis C. If positive, confirm with PCR.
3. ELISA for HIV-1 and HIV-2 and PCR for HIV-1: Remember that it can take up to 3 months to develop antibodies if exposure resulted from an unsterile injection or other blood exposure. A negative PCR test in children less than 3 months may not be reliable and should be repeated.
4. VDRL or RPR for syphilis: FTA – IgG antibodies for children < 12 - 15 months old whose biologic mothers are reported to have syphilis.
5. Mantoux test (intradermal PPD) for TB with Candida control even if the child has received BCG vaccination: Do not attribute a positive Mantoux test to BCG without further investigation.
6. Stool for Ova and Parasites: If the lab offers antigen testing for Cryptosporidium and Giardia, the antigen test should be supplemented with a microscopic exam. The possibility of Isospora should be considered. One stool specimen is sufficient unless symptomatic. Keep in mind that not all intestinal parasites require treatment. Children with diarrhea should have stools cultured for Salmonella, Shigella, Yersinia and Campylobacter.
7. CBC with erythrocyte indices to screen for anemia and hemoglobinopathies. Sickle cell screening may be appropriate for some children.
8. Serological titers to confirm effectiveness of reported vaccinations: Diphtheria, Tetanus and Hepatitis B. Alternatively re-immunize to DPT and polio.
9. Dipstick UA.
10. Serum lead levels in children > 12 months of age.
11. TORCH titers for microcephaly and severe developmental delay.
12. TSH and toxoplasmosis titers for relative macrocephaly and developmental delay.
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Bacteria |
Viruses |
Protozoa |
Helminths |
Arthropods |
Campylobacter |
Cytomegalovirus |
Amebiasis |
Ascariasis |
Lice |
Melioidosis* |
Hepatitis A |
Giardiasis |
Filariasis* |
Scabies |
Salmonella |
Hepatitis B |
Malaria* |
Hookworm |
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Shigella |
Hepatitis C |
Toxoplasmosis |
Liver flukes* |
|
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Syphilis |
HIV |
|
Lung flukes* |
|
|
Tuberculosis* |
|
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Schistosomiasis* |
|
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Typhoid fever* |
|
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Strongyloidiasis |
|
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Leprosy |
|
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Tapeworm |
|
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Trichuriasis |
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* Most commonly encountered in refugee children than in international adoptees.
References:
1. The Pediatric Red Book, 1997, pages 116-120.
2. Ped Inf Ds J 1998; 17:517-518.
3. Adv Pedatri Inf Dis 1999; 14:147-161.