Internationally adopted children: let us not think only about infections!

Key words: Health status, infectious and non-infectious diseases, Screening protocol, Special needs

Background - According to the most recent statistic report by the Italian Commission for International Adoptions, in the period 2014-2015 Italy was the Nation with the highest rate of adoptions in Europe and the second one worldwide, following the United States.
Objective - The aim of the present study was to evaluate the health status of internationally adopted children (IAC) to identify the most serious problems regarding both infectious and non-infectious diseases, which are not frequently diagnosed or are or are often misdiagnosed.
Materials and methods - All IAC referred to the Centre for the Internationally Adopted Child (Anna Meyer Children’s University Hospital, Florence, Italy) from October 2015 to June 2017 were prospectively enrolled. All the children underwent the screening protocol including a physical, laboratory and instrumental examinations. Also special needs prevalence was assessed and their possible risk factors explored.
Results - Overall, 422 children were included with a median age of 6.5 years at the first evaluation (interquantile range: 3.9-9.4). One hundred seventy-seven (41.9%) presented with an infectious disease. Among them, the most frequent ones were parasitic infections (23.5%), latent tuberculosis (9.5%) and cutaneous diseases such as Molluscum contagiosum (1.7%), scabies (0.9%) and Tinea capitis (0.7%). Special needs prevalence was 17.1% (72/422) and most children came from Europe (31.7%, 40/126; P < 0.0001). At multivariable logistic regression analysis, factors significantly associated with the presence of a special need were: age lower than 5 years and the origin from East European countries.
Conclusions - The present study shows that IAC are at risk of non-infectious problems with a higher prevalence than previously reported: 1 child out of 6 presented with a special need. Paediatricians should pay a special attention to Russian children, among whom almost 1 out of 2 carried a foetal alcohol spectrum disorder, which is not often recognised.