A total of 57 children (21 female, 36.8%) were included, with a median age upon arrival in Spain of 27 months [IQR: 17–39]. 48.2% of adopting families corresponded to single-parent families. Among the adoptees, the Asian origin was predominant: 36 children (63.2%) from China, 18 (31.6%) from Vietnam, 1 (1.8%) from India, 1 (1.8%) from Ethiopia, and 1 (1.8%) from Bulgaria. In their country of origin, 73.7% lived in orphanages and 5.3% with a foster family. One child (1.8%) had been hospitalized since birth. In 90% of the minors, the family history was unknown.
The pathologies reported in the pre- and post-adoption visits are compared in Table 1. The pathology that motivated the IA via SN was confirmed in 45 children (79%). Of the remaining 12, 8 were completely healthy children, and 4 had other minor pathologies.
Table 1
Pre and post-adoption pathology
|
Pre-adoption results, N (%)
|
Post-adoption results, N (%)
|
|
General Pathology
|
57/57 (100)
|
57/57 (100)
|
p
|
Palatal malformation
|
12 (21.0)
|
12 (21.0)
|
1
|
Cardiopathy
|
9 (15.8)
|
12 (21.0)
|
0.468
|
Operated congenital cardiopathies
|
6 (10.5)
|
6 (10.5)
|
|
Interatrial communication
|
1 (1.8)
|
0
|
Patent foramen ovale
|
2 (3.5)
|
3 (4.8)
|
Other
|
0
|
4 (7.0)
|
Digestive pathology
|
9 (15.8)
|
6 (10.5)
|
0.405
|
Operated digestive tract malformations
|
5 (8.8)
|
5 (8.8)
|
|
Abdominal wall malformations
|
2 (3.5)
|
0
|
Digestive problems
|
3 (5.3)
|
1 (1.8)
|
Neurological pathology
|
14 (24.6)
|
22 (38.6)
|
0.106
|
Neurodevelopmental delay
|
4 (7.0)
|
6 (10.5)
|
|
Alterations in craniofacial morphology
|
7 (12.3)
|
8 (14.0)
|
|
Macrocephaly
|
1 (1.8)
|
1 (1.8)
|
|
Microcephaly
|
0
|
17 (29.8)
|
|
Sensorineural deafness
|
2 (3.5)
|
2 (3.5)
|
|
Intracranial hypertension
|
1 (1.8)
|
1 (1.8)
|
|
Infectious pathology
|
7 (12.3)
|
17 (29.8)
|
0.021
|
Intestinal parasitosis
|
0
|
8 (14.0)
|
|
Systemic parasitosis*
|
0
|
11 (19.3)
|
Congenital infections
|
6 (10.5)
|
1 (1.8)
|
Other
|
1 (1.8)
|
1 (1.8)
|
Dermatological pathology
|
6 (10.5)
|
8 (14.0)
|
0.568
|
Angioma
|
2 (3.5)
|
2 (3.5)
|
|
Atopic dermatitis
|
3 (5.3)
|
3 (5.3)
|
Scabies
|
1 (1.8)
|
1 (1.8)
|
Vitiligo
|
0
|
1 (1.8)
|
Allopecic plaque in scalp
|
0
|
1 (1.8)
|
Supected endocrinopathy
|
-
|
5 (8.9)
|
-
|
Respiratory pathology
|
5 (8.8)
|
1 (1.8)
|
0.093
|
Orthopedic pathology
|
3 (5.3)
|
3 (5.3)
|
1
|
Visual anomalies
|
4 (7.0)
|
8 (14.0)
|
0.222
|
Visual acuity alteration
|
3 (5.3)
|
7 (12.3)
|
|
Retinopathy of prematurity
|
1 (1.8)
|
1 (1.8)
|
Hematological pathology
|
14 (22.6)
|
4 (7.0)
|
0.012
|
Anemia not otherwise specified
|
9 (15.8)
|
2 (3.5)
|
|
Talasemia
|
4 (7.0)
|
2 (3.5)
|
Jaundice
|
1 (1.8)
|
0
|
Delay in pondero-statural growth
|
1 (1.8)
|
10 (17.5)
|
<0.05
|
Serologies (congenital infections)
|
56 (98.3)
|
57 (100)
|
|
Anti-HIV antibodies (tested)
|
53 (93.0)
|
57 (100)
|
|
Positive results
|
0
|
0
|
|
Syphilis (RPR and/or VDRL tested)
|
51 (91.1)
|
57 (100)
|
|
Positive results
|
2 (3.9)
|
0
|
|
HBs antigen (tested)
|
55 (96.5)
|
57 (100)
|
|
Positive results
|
1 (1.8)
|
0
|
|
Anti-VHC antibodies (tested)
|
3 (5.3)
|
57 (100)
|
|
Positive results
|
1 (33.3)
|
1 (1.8)
|
|
All patients with a previous diagnosis of palatal malformation, congenital heart disease, or intervened digestive malformation were confirmed (Table 1). Two patients reported a prior diagnosis of inguinal and umbilical hernia, neither of which were observed in the post-adoption consultation.
Concerning patients with pre-adoption reported neurological pathologies, those were confirmed, and new diagnoses were added, in addition to 17 cases of microcephaly not previously described.
According to the pre-adoptive report, out of six children with presumed congenital infection (three congenital syphilis, one hepatitis B, one hepatitis C, and one CMV infection), only one adequately treated congenital syphilis could be confirmed). All the parasitic infections were post-adoption diagnoses.
Regarding the dermatological pathology, two patients had in their reports major vascular malformations that were the reason for adoption via SN (a dorsal hemangioma and a cervicobrachial hemangioma), both of which were confirmed on arrival.
Four new cases of endocrinopathies were diagnosed during the medical assessment and follow-up (one case of hypothyroidism, one of precocious puberty, and two of methylcrotonylglycinuria). Additionally, another child presented on arrival with an alteration in the metabolism of acylcarnitines (an increase in the C3/C2 ratio in the metabolic screening), that was later improved, probably related to better nutrition after adoption.
Of the five patients with a previous diagnosis of respiratory disease (1 bronchitis, 2 recurrent bronchospasms, 1 tracheitis, and 1 bronchopulmonary dysplasia), only one case of asthma was confirmed post-adoption.
Orthopedic pathology was reported in three children: 2 genu varo that were confirmed and a congenital dislocation of the hips that was not evident upon arrival. However, an undiagnosed genu varo was discovered in a patient with palatal malformation.
In the first post-adoption visit, 23.2% of the children were underweight, and 33.3% were low-height, with 17.5% of adoptees meeting DPSG criteria compared to 1.8% according to the pre-adoption reports.
The results of the most relevant complementary tests from the first visit are presented in Table 2, highlighting the infectious pathology in 17/57 (29.8%) children.
Table 2
Complementary tests performed after first visit upon arrival.
Laboratory tests
|
|
Hemoglobin
|
Median 13 mg/dL, IQR (12-14)
|
Anemia
|
4/56: 7.1%
|
Iron
|
Median 29 ug/dL, IQR (20-40)
|
Iron deficiency (≤ 15 ng/ml)
|
9/53 (17%)
|
Eosinophils
|
Median 195 cél/µL, IQR (147-330)
|
Eosinophilia (> 500/ml)
|
7/56 (12.5%)
|
Microbiology
|
|
Serologies
|
|
Schistosoma spp
|
7/40 (17.5%)
|
Strongyloides stercoralis
|
3/49 (6.1%)
|
Toxocara canis
|
3/49 (6.1%)
|
Positive Plasmodium antigen
CMV IgG
|
0/10
24/28 (85.7%)
|
Stool studies
|
|
Parasites detected*
|
7/56 (12.5%)
|
Ag Cryptosporidium o Giardia lamblia
|
1/37 (2.7%)
|
Tuberculosis screening
|
|
Positive tuberculin skin test
|
4/54 (7.4%)
|
IGRA
|
0/5
|
Metabolic screening
|
|
Normal
Non conclusive
Increase in C3/C4 ratio
|
41/44 (93.2%)
2/44 (4.5%)
1/44 (2.3%)
|
A signed and stamped immunization schedule was provided by 91.2% of the children. Still, only in 7.7% of the patients, this document included all the vaccines recommended for age according to the immunization schedule of their country of origin.