• Hepatitis B surface antigen [carrier state for Hep B] 251 infants/children were tested, or 96% of the group.
  96% negative [ 243 infants/children were negative for hep B ]
  3.2% positive [ 8 infants/children of 251 were positive for Hep B surface antigen
  [11 infants/children were not tested]
  1 child who tested positive on arrival, converted to negative status without treatment six months later [Comment: about 1% per year may convert to neg.]
  1 child who tested positive on arrival in 1994, and had abnormal liver function tests, was treated with Interferon, and is negative as of 1996, including Hep B viral DNA undetectable. [Comment: interferon treatment has been shown in quite a number of studies to be very helpful in those children who do have/develop abnormal liver enzymes, and with fewer side effects than previously thought.]
  The other 6 infants/children who remain positive all have normal liver function tests, and are totally healthy. They are monitored regularly by their doctors.
  
  
• Hepatitis B antibody [signifying that the infant/child once had the infection, got over it without harm, and is now permanently immune]
  211 infant/child test {81% tested } 14 % immune [30 inf./child. of 211 were positive [immune]
  By extrapolation, 37 infants/child of the total 263 were immune :
  [Comment: 7 infants/children undoubtedly received 3 shots each of hep B vaccine in the US which they did not need - costs: pain and money, and positively will not convert a positive to negative, as some parents were misinformed.]
  
  
• Hepatitis A Antibody [signifying that the infant/child once had the infection, got over it without harm, and is now permanently immune]
  114 infants/children tested = 44% tested
  6% immune [7 inf./child. of 114 were positive [immune]
  Comment: currently this note is of academic interest only, but Hep A vaccine will be increasingly widely used in the future, and the test can be included in “hepatitis panel request” using no more blood and at very minimal cost.
  
  
• Lead testing:
  207 inf/child. tested = 80% tested within 3 months of arriving in US
  12% [25 inf/child. ] had abnormal levels
  6.8% [14 inf/child ] had levels 10 - 15 micrograms
  1.4% [3 inf/child ]had levels 15 - 20 micrograms 1.4 % [ 3 inf/child ] had levels 20-25 micrograms
  2.5% [ 5 inf/child ] had levels over 25 micrograms [3 of these children, with levels 37,37, and 50 were treated with lead lowering medications] [Comment: An additional 8 inf/child. were lead tested Later [5 to 12 months after arrival] and found to have lead levels above 10; one child had a level of 16 mcg 5 months after arrival, one child had 14 mcg 8 mos after arrival. It is possible, but unlikely, that they picked up lead in the US: It is possible, and likely, that they had really high levels on arrival, and perhaps should have been treated. Adding the "late positives" to those tested in the arbitrarily set 3 mos window, !6 % of the children arrived with lead levels over the US safe standard of 10 micrograms. Lead, and its implications, is a vast topic which could be explored in a later newsletter. Many feel the US standard of 10 is too low:
  
• Syphilis Status ; Negative test [signifies that the infant/child does not have syphilis] 108 infants/children were tested = 41% tested 0 infants/children had the infection
  
• AIDS 42 infants/children tested; none were positive [Comment: no AIDS positive Chinese adoptee has been reported in the US]
  
• Tuberculosis Status: Negative test signifies that the inf./child had not been significantly exposed to Tb and did not have the infection 222 infants/children tested = 85% tested 1.5% positive [4 infants/children were positive for Tb exposure [Comment: None of the skin-test positive infants/children had Tb by x-ray exam. Some were treated with isoniazid preventively, all are healthy.]
  
• Intestinal Parasites and Bacteria 229 infants/children tested = 87% tested 12% positive [27 infants/children were positive for parasites or bacteria] [Comment: all children are healthy now; some did not even need treatment.]
  
• Thyroid Hormone testing 116 infants/children were tested = 44% tested 4% abnormal [ 5 inf/child. of 116 had abnormal results] [Comment: All five children have been treated and are normal. If all 263 inf/child were tested, one would expect 10 abnormal results. Thyroid abnormality can effect cognition and often has no obvious physical signs. China has large areas without iodine, necessary for thyroid function, available.]
  
• Complete Blood Count testing 243 infants/children were tested = 93% tested 12% [ 29 inf/child had hemoglobin counts less than 11 milligrams] 5% [12 infants/children had hemoglobin counts less than 10 milligrams] [Comment: Most of the children were treated with iron rich feeding; a few required medicinal iron; all are now normal.] [8 children were found to have thalessemia trait, a harmless genetic mild anemia which requires no treatment.]
  
• Other Medical Issues [N=263]

  About 12 of the infants/children were adopted into families where the child's special need was expected from the medical report sent from China ahead of the adoption. These medical problems included extra fingers and toes, missing fingers and toes, cleft lip and/or cleft palate, crossed eyes, club foot, heart murmurs, hearing loss, and rickets. All these children have received thorough medical care, some needing surgery, and are doing well. Several other children were found to have medical issues on exam in China such as dental problems, congenital hip dysplasia, heart defects not requiring surgery (ventricular septal defect, pulmonic stenosis), and crossed eyes (strabismus). All these children came home with their families by choice.Two children developed serious seizure disorders as they matured: both have been treated at university medical centers, and their seizures controlled by medications. Two children were found to have congenital hip dislocations; both have been treated, and are now normal. Otherwise, there have been the same types of childhood infections - ears, chest infections, stomach and bowel upsets- as are seen worldwide in all children, but actually fewer than expected. There have been no deaths.
  

• Behavior and Developmental Assessment [N=260 ] 7% [18 children] have been found to have significant expressive language delay 6% [15 inf./child] have had mild motor delay [ past the usual 3 months period we anticipate for “catch up”] 3% [ 9 inf/child] have had moderate motor delay 1% [3 inf/child] have had moderately severe motor delay [Comment: Most of these children have been working with their parents in "Early Intervention" programs, and even the most significantly delayed has made progress. 3% [8 children ] were said by their families to have moderate to severe behavior issues. 1 child, adopted at 3 yrs, had severe attachment problems. Her very loving family has worked very hard on this and she is now fine. 2 parents of infants 8-10 months reported attachment issues, now resolved. 4 families said their child had problems with temper tantrums, 2 reported "very aggressive" behavior, and 2 "very stubborn". 40% [104 children] were reported by their doctors and/or parents to be "superior in intelligence; advanced in all areas." The children were further described by such phrases: "a genius". "a great athlete", "a beauty". "a great joy", "she is a very social, outgoing child", "I cannot imagine my life without her", "She is imaginative, humorous and a delight", "You would think she practically had a PhD degree."
  

Editor's Note: Dr. Hendrie, formerly chief of pediatrics at Emerson Hospital in Concord, Ma., has worked as a pediatric consultant for children adopted from China since 1994. Traveling to China 21 times, she has seen more Chinese orphanages and examined more of our adopted children than any other American pediatrician. Curious to study the overall health of Chinese adoptees, Dr. Hendrie undertook this study on her own, contacting many of the families she had worked with. To date, it is the most complete picture of the general health of Chinese adoptees that we currently have.