The purpose of the newborn screening is to provide important information about the child’s health that you were even your doctor may not otherwise know about.  The screening programs identify different rare medical disorders such as rare metabolic conditions, endocrine problems like congenital adrenal hyperplasia, thyroid conditions.  The newborn screening is also suitable to screen for blood disorders such as sickle cell disease and other hemoglobinopathies as well as some infectious conditions like HIV infection.

From all the countries which I do pre-adoption medical evaluations for, Guatemala is the only country where the newborn screening tests seems to be routine.  In the United States every state has a newborn screening program but at each state screens for different conditions.  The New York State screening program can check for more than 40 different disorders.  Some of these conditions may be life-threatening and others may slow down the baby’s development.  Most infants that have one of these underlying conditions show no signs or symptoms of the conditions and they may seem very healthy in the immediate period after their birth.  Please be aware that the conditions that are checked during newborn screening are very rare and a majority of the babies have negative results.

The testing process is relatively simple. The tests are performed on a tiny sample of blood obtained by prick in the baby heal and applying the blood specimen to a special transport paper.  The sample is then sent to a reference lab for testing. The reference lab that I have seen performing newborn screening tests on babies adopted from Guatemala is a company called Pediatrix Screening. Your adoption agency should be able to help you to have this test performed.  If that is not possible you as a parent may visit the website www.pediatricx.org and purchase the newborn screening kit and have it sent to a medical professional caring for this infant.

If on a newborn screen the results return requiring a retest, this does not necessarily mean that the child has a disorder.  Retesting may be needed for a number of reasons.  The most common being at this first sample contained too little blood to complete all the tests,  in this does not necessarily mean that there is anything wrong with your child.  When one of the preliminary tests indicate the problem these results cannot be considered confirmatory until they are redone this would require a new specimen and you will need to have a physician evaluate the results.  This physician contact is important in order to determine whether the child needs immediate medical management while waiting for the retesting results.  Fortunately in my own general pediatric practice I have seen very few abnormal newborn screenings that had real medical conditions.  The vast extensive majorities were all false positive tests and when they were repeated they were normal.  In my international medical practice, obviously the volume of newborn screenings results that I receive are considerably less than in my general practice but fortunately I have only witnessed normal newborn screening results.

Written by George Rogu M.D.

Today I will write about little Jeremy who is only 6 months old, and only recently arrived to the United States from Guatemala.

While still in Guatemala, Jeremy was slightly ill with a slight case of Diarrhea. The agency and parents wanted to make sure that nothing would delay the Adoption process so they did not seek medical attention while still in Guatemala. After 2-3 in the U.S.A., Jeremy still had persistent diarrhea and the mother was concerned, so she proceeded to a local emergency room. The doctors felt that the child was dehydrated so Intravenous fluid…

Today I will write about little Jeremy who is only 6 months old, and only recently arrived to the United States from Guatemala.

While still in Guatemala, Jeremy was slightly ill with a slight case of Diarrhea. The agency and parents wanted to make sure that nothing would delay the Adoption process so they did not seek medical attention while still in Guatemala. After 2-3 in the U.S.A., Jeremy still had persistent diarrhea and the mother was concerned, so she proceeded to a local emergency room. The doctors felt that the child was dehydrated so Intravenous fluid were started and some preliminary blood work was drawn. Because Jeremy was very robust and dehydrated, the drawing of the blood specimen was very difficult. After a few hours of IV fluids, Jeremy perked up and began to drink fluids; he was given a diagnosis of “A Stomach Virus”.

The results of the blood work did not get posted yet, but since it was really late and the child was doing well, the decision was made to send the child home with follow-up with his pediatrician. “We will call you with the results if anything is abnormal” Sure enough, a few hours later, a oncologist “Cancer doctor” calls Jeremy’s mother with a grave concern that he may have Leukemia and must return to the hospital for Admission, blood test, maybe a bone marrow. The mother was devastated. She had just adopted Jeremy only 4 days ago how could this be? She returned with Jeremy the next day to the hospital as instructed, and a repeated blood specimen was taken which was completely normal.

Jeremy’s mother related to me that this was the worst night that she has ever had. I had seen the infant as follow-up from the emergency room visit and explained tried to explain what happened to her. Why one result was abnormal and one was normal. It was very simple. The child being very robust and dehydrated, the blood clotted in the specimen container, and because of this, the values of the bloodlines were all distorted. If Jeremy’s mother would have went to a children’s hospital they would have know to just repeat the specimen and not alarm the parents with false values. Sometimes too much information is not good. Jeremy is doing well now, no leukemia. Just a case of late night misinformation.

George Rogu M.D.
Medical Director of Adoptiondoctors.com and Adoptioneducationclasses.com

Read Full Story at Angelina Jolie Part of Latest Wave of Celeb Adoptions

(CNN) — The world’s worst-kept secret was confirmed on Friday as Madonna flew out of Malawi after her nine-day “humanitarian mission” having apparently made arrangements to adopt a 13-month old boy.

Read full Story at CNN: Who benefits from celebrity adoptions? 

The controversy over Madonna’s adoption of one-year-old David Banda of Malawi has put a spotlight - and fresh scrutiny — on celebrities who adopt, especially those who take in children of different backgrounds from their own.

Read full story at Netscape Celebrity: ‘Adoption Fever’ Among Celebrities - Good or Bad?

Americans adopting from Ethiopia have the unique privilege of meeting and visiting with the biological family, if they are known, in their villages. It is an opportunity which should be eagerly accepted because in years to come it will give your child tangible information about his/her ancestry, photographs for your child’s Life Book and yield important medical and psychological information about family genetics. This meeting will give a window into the circumstances for the adoption and provide the chance to obtain medical information from the birth family and officials and to take family pictures. These materials, as well as a few strands of hair from the birth mother, should be sent to your pediatrician while you are in Ethiopia or maintained for future genetic testing. In years to come DNA will provide a wealth of information to adoptive families and your doctor will be the repository of these materials and alert you to the latest findings.
When in Ethiopia your child will be cared for in the orphanage by nannies, nurses and doctors. Your youngster will also receive check-ups from an outside physician in his/her office. If you have questions and are uncomfortable with the answers feel free to ask for a team consultation, as I did, with all the professionals involved with you child. If you continue to be concerned contact your physician in America for clarification before bringing your child home. Most importantly know that your child will receive inoculations in Ethiopia and must be in good health to qualify for the America visa. Your child will receive a final check-up in Ethiopia to certify these requirements have been met.

In addition to knowing your child’s health and birth family you will meet the youngster you only “knew” from a photo within hours of your arrival in Ethiopia. Be aware that when you land in Addis Ababa you will be jetlagged from the long, exhausting trip. Therefore take the opportunity to get some rest, eat lightly and be refreshed when you meet your child. You want to feel your very best and be ready for one of the most joyous occasions you will experience. As you prepare to meet for the first time remember that your little one is not accustomed to many visitors or being held by newcomers. It will take both of you time to get acquainted. Enlist the assistance of the nannies who, although you may find them possessive in the beginning, will be a fund of information and full of helpful tips once you are assertive and they understand your good intentions. So spend as much time as you can during the first days in your child’s care center observing your child’s feeding schedule, appetite, sleep pattern and temperament. Get accustomed to feeding and bathing your child because in a few days the child you have been visiting daily will be placed in your custody. It will then be your decision to stay in the orphanage’s guest house or a hotel of your choosing, while you await completion of your paperwork. And in a few more days you and your child will journey home to America to start a new life. One of the great advantages of Ethiopian adoption is the streamlined procedures and the abbreviated schedule, which is usually completed within 5-7 days of your arrival in Ethiopia.

A few words of wisdom when you return home: minimize the number of visitors during the first weeks. This is a major life change for your youngster and time is needed to rest from the long flight and to adjust to new formula/food and the immediate family.

You and all those who love you and your new child will have a lifetime to celebrate.

Written by: ROBERTA KALMAR, LMSW
www.abcadoptionsonline.com

Ms. Kalmar, a specialist in adoption home studies and international adoptions, served as a social work consultant and child care center volunteer in Addis Ababa, Ethiopia during 2006. She accompanied one of her clients to adopt her 8 month old daughter. The above account is based on her experiences in Ethiopia and follow-up visits with the adoptive family. For further information: ROBERTA KALMAR www.abcadoptionsonline.com 718-499-8993

Poor visual acuity is one of the most important medical factors that can contribute to poor behavioral, developmental and academic achievement in a child if left untreated.

The actual country of birth of the child is irrelevant, but there has been a documented increased prevalence of eye problems such as Strabismus and ambyopia in the internationally adopted child, especially the ones that were adopted from Eastern European countries.

In infants and children, in order for visual development to proceed normally, visual experiences must occur with well aligned eyes that are free from eye pathology and other visual acuity errors. One of the consequences of not fulfilling theses visual requirements during the early years of life could lead to disorders like strabismus, ambyopia, and decreased visual acuity. In the general population, the aforementioned visual disturbances are reported to occur in 2%-3% of the general pediatric population. In the United States, physicians and school nurses are very good at screening for such problems. In the case of the institutionalized child, one would speculate that because of the lack of general medical care, conditions such as “Lazy Eye” or “Cross Eyed” would go undiagnosed and untreated for an extended period of time. Basic medical care is generally considered a luxury for those unfortunate enough to reside in an Institution. Routine vaccinations, correctable surgical conditions and basic medications such as antibiotics are often lacking, so why should we expect these children to have an annual vision screen. It therefore should not come as a surprise that many orphan children have amblyopia and strabismus.

Amblyopia is reduced vision in an eye that has not received adequate stimulation or usage during early childhood. It basically means “without sight.” Amblyopia has many causes, among them being a “lazy” eye. Amblyopia most often results from this “lazy” or misalignment of the child’s eyes. A “lazy” eye is seen by an observer as crossed eyes, or divergent eyes. Amblyopia also results from a difference in image quality between the two eyes (one focusing better than the other). In both cases, (misalignment and weaker focusing), one eye becomes stronger than the other. If this condition persists, the weaker eye may become useless. Visual acuity tests and newer technology such as the Visual evoked potentials are some of the best ways to screen for these visual disturbances. These screening tests are generally performed at the routine well child visits, vision screen performed by an ophthalmologist or by the school nurse. The test may pick up abnormalities if they are present at the time of the examination. A child may have normal vision on today’s examination, and over the course of the following year, visual disturbances occur and it is picked up at the next check-up examination. This is why annual vision screens are performed in children.

Strabismus is a misalignment of the visual axes of the two eyes. The eyes can turn inwards or outwards Children appear to be cross eyed. Strabismus may cause or may be due to amblyopia.

With early diagnosis and treatment, the vision in the “lazy eye” may be restored.
The earlier the treatment, the better the opportunity to reverse the vision loss. Before treating Amblyoia, it may be necessary to first treat the underlying cause. Glasses are commonly prescribed to improve focusing or misalignment of the eyes. In extreme cases, surgery may be required to allow both eyes to work together.

Eye exercises are a limited form of treatment. The correction may be followed by: Patching or covering one eye may be required for a period of time ranging from a few weeks to as long as a year. The better-seeing eye is patched, forcing the “lazy” one to work, thereby strengthening its vision. Medication - in the form or eye drops or ointment - may be used to blur the vision of the good eye in order to force the weaker one to work. This is generally a less successful approach.

I am not sure of the exact percentages of Strabismus or Amblyopia for children that resided in institutions. In my own personal experience I have found that there is an increased incidence of referrals that I make to the pediatric ophthalmologist in my International adoption cases, especially for those children from Eastern European countries.

Written by George Rogu M.D. for Adoptiondoctors.com

* Note: The information and advice provided is intended to be general information, NOT as advice on how to deal with a particular child’s situation and or problem. If your child has a specific problem you need to ask your pediatrician about it — only after a careful history and physical exam can a medical diagnosis and/or treatment plan be made. This website does not constitute a physician patient relationship

George Rogu M.D. Medical Director and founder of Adoptiondoctors.com and adoptioneducationclasses.com Adoptiondoctors.com is an innovative adoption medicine educational service, dedicated to helping parents and adoption agencies with the complex adoption related medical issues encountered in the internationally adopted child. Pre-Adoption medical record evaluations and Blind Referral support services are also provided via this website. Post-Adoption Medical Care provided in our Adoption Friendly General Pediatric Private practice, in Long Island New York. For more information Adoptiondoctors.com

Hepatitis C viral tests detect substances in the blood that indicate a hepatitis infection is active, chronic, or has occurred in the past. The tests detect proteins (antibodies) or genetic material (DNA or RNA) of the virus that causes hepatitis. It is important to identify the type of hepatitis virus causing infection so that its spread can be prevented and the proper treatment can be started immediately. Anti-HCV antibody tests detect the presence of antibodies to HCV in the blood, indicating an HCV infection has occurred. However, this test makes no distinction between an acute or chronic infection.

The enzyme immunoassay (EIA) may be the first test done to detect anti-HCV antibodies. Sometimes a supplemental test called the recombinant immunoblot assay (RIBA) may be done to confirm a positive EIA test result.
This test can tell whether a positive result was from an actual HCV infection or whether the result was a false-positive.

HCV genetic material (RNA) testing uses polymerase chain reaction (PCR) to detect the RNA of an active hepatitis C infection. The RNA can be detected in a person’s blood within 1 to 2 weeks after exposure to the virus. HCV RNA testing may be done to confirm a positive result on an HCV antibody test, define the level of virus in the blood (called viral load), or predict the likelihood that a person with HCV will respond to medical treatment. Another RNA test called genotyping can define the strain of hepatitis C and indicate how likely it is to respond to treatment.

HCV quantitative test or viral load is often used before and during treatment to determine how long treatment needs to be given and to monitor your response to treatment. HCV viral genotyping is used to determine which genotype of the HCV virus is present. HCV has 6 genotypes, and some are more responsive to treatment than others. There is no preventive vaccine available for Hepatitis C. It is recommended that all children at risk for Hepatitis C be immunized for both Hepatitis A and B.

Nicholas Rogu, M.D. of www.rbkpediatrics.com for www.adoptiondoctors.com

* Note: The information and advice provided is intended to be general information, NOT as advice on how to deal with a particular child’s situation and or problem. If your child has a specific problem you need to ask your pediatrician about it — only after a careful history and physical exam can a medical diagnosis and/or treatment plan be made. This website does not constitute a physician patient relationship.

The heart is divided into four basic chambers. The septum is a wall that separates the heart’s left and right sides. Septal defects are sometimes called a “hole” in the heart. A defect between the heart’s two lower chambers (the ventricles) is called a ventricular septal defect (VSD). When there is a large opening between the ventricles, a large amount of oxygen-rich (red) blood from the heart’s left side is forced through the defect into the right side. Then it’s pumped back to the lungs, even though it’s already been refreshed with oxygen. This is inefficient, because already-oxygenated blood displaces blood that needs oxygen. This means the heart, which must pump more blood, may enlarge from the added work. High blood pressure may occur in the lungs’ blood vessels because more blood is there. Over time, this increased pulmonary hypertension may permanently damage the blood vessel walls. If the opening between the ventricles is small, it doesn’t strain the heart. In that case, the only abnormal finding is a loud murmur.

Surgical closure of small VSD’s may not be needed. They often close on their own in childhood or adolescence. But if the opening is large, even in patients with few symptoms, closing the hole in the first two years of life is recommended to prevent serious problems later. Usually the defect is closed with a patch. Over time the normal heart lining tissue covers the patch, so it becomes a permanent part of the heart. Some defects can be sewn closed without a patch. Repairing a VSD restores the blood circulation to normal. The long-term outlook is promising.

Children with this VSD’s should be examined regularly by a pediatric cardiologist. They will make sure that the heart is working normally. Most patients won’t need to limit their activity. However, if they develop pulmonary hypertension or the heart doesn’t pump as well as it used to, their activity may need to be somewhat limited to ensure their safety.

Most people with uncomplicated ventricular septal defects that have been repaired early in life don’t have any significant long-term problems. In some individuals, the heart muscle may be less able to contract. This requires diuretics, agents to help the heart pump better and drugs to control blood pressure. In addition, if pulmonary hypertension develops (it’s uncommon), the child may require additional treatment. In children with surgically repaired ventricular septal defects, additional surgical correction is rarely needed unless residual defects are seen afterwards. If this occurs, whether they will require surgery depends upon the size of the residual defects.

Written by Nicholas Rogu M.D. of www.rbkpediatrics.com for www.adoptiondoctors.com

* Note: The information and advice provided is intended to be general information, NOT as advice on how to deal with a particular child’s situation and or problem. If your child has a specific problem you need to ask your pediatrician about it — only after a careful history and physical exam can a medical diagnosis and/or treatment plan be made. This website does not constitute a physician patient relationship