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Micronutrient Deficiencies, Growth Failure and Developmental Delays Are More Prevalent than Infectious Diseases in US Adopted Chinese Orphans

Abstract 735 Nutritional Issues in Underserved Populations Platform, Monday, 5/3

In FY 1998 China surpassed the Russian Federation to become the largest source of international adoptees for US families. Over 13,000 Chinese orphans have been adopted by Americans since 1991. The risk of infectious diseases such as hepatitis B, HIV and TB is of considerable concern to families adopting from China and their health care professionals. Less attention has been paid to other sequelae of early childhood institutionalization. The present study was undertaken to identify the prevalence of nutritional and developmental disorders as well as the prevalence of infectious diseases in Chinese adoptees. Over the period 1/91-10/98 information was collected via direct examination (42%) or via mail-in questionnaire (58%) from 357 Chinese children (98% F) adopted to the US. Children arrived at a mean age of 12.3±14 months (range=1-152 m) and spent an average of 9.7±9.8 months within an orphanage prior to adoption. None were HIV+ (n=342), 0.33% VDRL/RPR+ (n=305), 0.9% HCAb+ (n=109), 3.5% HBsAg+ (n=342), 5.1% PPD+ (n=174) and 7.1% positive (n=239) for interstitial parasites (predominantly Giardia and Ascaris). Nutritional investigation revealed that 9.2% (n=120) has a serum Fe<30 µg/dl, 14.3% (n=120) had an alkaline phosphatase > 300 Units/L and 15.4% (n=116) had a whole blood lead level of > 9 µg/dl. None had a serum albumin level < 4 g/dl (n=122). Of the 136 children examined by a physician for gross and fine motor skills, tone, strength, language and social abilities, 74% were abnormal in one or more areas at the time of arrival. Height delays (ht age - chronological age) correlated with the length of orphanage confinement (LOC) (ht delay in months = 1.09 + 0.4*LOC) (r = -.74, p < 0.0001). Chinese children lost one month of growth for every 2.5 months in an orphanage. Infectious diseases, particularly hepatitis B and TB are important issues in Chinese adoptees, however micronutrient deficiencies, growth failure, developmental delays and lead exposure are more prevalent problems. Careful evaluation of a child's nutritional and developmental status as well as exposure to lead are a necessary part of the post-arrival evaluation for all Chinese adoptees.

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Johnson, D., Traister, M. Micronutrient Deficiencies, Growth Failure and Developmental Delays Are More Prevalent than Infectious Diseases in US Adopted Chinese Orphans. Pediatr Res 45, 126 (1999).

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