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Dana E. Johnson, MD, PhD; Laurie C. Miller, MD; Sandra Iverson, MS, RN; William Thomas, PhD; Barbara Franchino; Kathryn Dole, OTR; Marybeth T. Kiernan, OTR/L; Michael K. Georgieff, MD; Margaret K. Hostetter, MD

JAMA. 1992;268(24):3446-3451.

Abstract
Objective.
—To determine the medical condition of Romanian adoptees and the effects of the Romanian orphanage system on their health.

Design.
—Case series.

Setting.
—The international adoption clinics at the University of Minnesota, Minneapolis, and the New England Medical Center, Tufts University, Boston, Mass.

Participants.
—Sixty-five Romanian adoptees who were brought to the United States during a 12-month period beginning in October 1990.

Main Outcome Measures.
—Incidence of hepatitis B, intestinal parasites, tuberculosis, syphilis, human immunodeficiency virus type 1, growth failure, and developmental delay.

Results.
—Although the adopted children were presumably chosen from the most vital and attractive adoptees, only 15% were judged to be physically healthy and developmentally normal. Fifty-three percent had serological evidence of past or present hepatitis B infection, and 20% of screened children tested positive for hepatitis B surface antigen. In children aged 7 months or older, the overall prevalence of chronic hepatitis B was 23%. Intestinal parasites were found in 33% of subjects, and 45% of infected children had two or more pathogens identified. All the children tested for human immunodeficiency virus type 1 were negative. Two patterns of growth failure were observed that resembled the two subtypes of psychosocial short stature that occur in association with prolonged psychological harassment or emotional deprivation. Infants' length, weight, head circumference, and weight-for-height were adversely affected by institutionalization. Older children's height was reduced. Only 10% of children older than 12 months were developmentally normal.

Conclusion.
—Romanian adoptees are an extraordinarily high-risk pediatric group as a consequence of decades of government-sanctioned child neglect and abuse.

(JAMA. 1992;268:3446-3451)

Author Affiliations
From the International Adoption Clinic, Department of Pediatrics (Drs Johnson, Georgieff, and Hostetter and Mss Iverson and Dole) and the Division of Biostatistics, School of Public Health (Dr Thomas and Ms Franchino), University of Minnesota, Minneapolis, and the International Adoption Clinic, Department of Pediatrics, New England Medical Center, Tufts University, Boston, Mass (Dr Miller and Ms Kiernan).

Footnotes
Reprint requests to Box 211 UMHC, 420 Delaware St SE, Minneapolis, MN 55455 (Dr Johnson).

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