| I must agree with you. Many times I view a video and the
child looks great yet when I review the medical records it is full of
medical diagnosis that sometimes scare me as a physician. It is because
of this reason that I became interested in children that are
internationally adopted. I remember the first IA evaluation that I
performed on a child who came from Russia. . This prospective adoptive
mother came to my General pediatric office, very happy that she had
received a referral of this beautiful 14 month little boy. She presented
to me her medical record which was laden with words like, perinatal
encephalopathy, pyramidal insuffiencey, and Vegeto-vascular syndrome.
After reviewing the case, I felt terrible because I thought that this
child according to Western Medical teaching may have been diagnosed with
Cerebral palsy, and how was I going to tell this happy woman that this
child was suspected of having severe brain damage.
It was only after I reviewed the video that I had realized that this
child does not look like a CP patient at all and nothing on the record
really made sense. I told the mother although this child looks very good
on the video in terms of developmental milestones, I find it hard to
ignore the term Perinatal encephalopathy.
I was confused and I let her know that. She told me not to worry
because she feels that this little boy is meant to be hers and that all
International adoptions are generally a leap of faith. I was dumfounded
by these records so I just used my medical reasoning and my gut feeling
to say that the child looks good despite what the records actually
state. I am happy to say that little Christian today is 8 years old and
doing great, walking, talking, and running just like all the little boys
in his mainstream classroom.
In this article I would like to try to explain some of the common
diagnosis found on the Russian medical records and what they actually
mean. I would like to reiterate however that even though these terms
appear commonly on many of the abstracts they should not be easily
dismissed just because they are common. Each child should have the
records and video evaluated by a doctor with and interest and experience
in International adoption.
The IA Doctors role is not to tell you which child to adopt or not to
adopt because this is an unrealistic expectation because they are unable
to physically examine the child. The IA Doctors role is more of an
parental educator for the adoptive families. They need to explain all
diagnosis, examine the video for milestones and any strange facial
features. These things need to be explained in simple terms and all
questions need to be answered. Once the family has a thorough
understanding of the child's medical condition, then the family can take
a calculated leap of faith.
1) Abnormal
chordae (trabeculae): Extra muscle tissue in the
wall of the heart, sually the left ventricle This feature is found with
the help of an echocardiogram of the heart.
This is an "incidental finding;* it does not cause any symptoms or
medical disease.
2) Intestinal
Dysbacteriosis: Loose or diarrheal stool following lack
of breast-feeding, illness or a course of antibiotics. This occurs
secondary to changes in the normal bacterial flora of the intestine.
Treated first with an antibiotic to decontaminate the gastrointestinal
tract and then with "ferments and enzymes," similar to our
treatment with lactase (milk sugar enzyme) or lactobacillus.
3) Hyperexcitability
(neuro-excitability, neuro-reflex irritability) syndrome: Similar to muscular dystonia but diagnosed within the first 3 months of
life. Noted when the infant has marked reactions to" stimuli (such
as being moved or disturbed), especially if tremor, increased newborn
reflexes, trembling chin or frequent belching is present. It may result
in movement disorder at an older age. In the U.S.A we do not make
mention of this and just state that they are normal newborn reflexes.
4) Hypertension-
hydrocephalic syndrome: Clinical diagnosis based on one
or more criteria alone or in combination:
seizures
increased muscle tone brisk reflexes
firm or tease fontanel (soft spot)
pulsation of me fontanel
tremor
jitteriness
large head circumference
dilated blood vessels over the scalp
prominent or bulging eyes
"sundowning" of the eyes
bluish discoloration over the bridge of the nose.
May be confirmed by ultrasound of the brain looking for dilation of the
ventricles medical pathology occurs when these ventricles become
enlarged because of accumulation of this fluid in the brain, thus
causing a very large head. Considered in most children to be a transient
condition secondary to the birth process. Treated with certain vitamins,
diuretics, and/or other drugs to improve blood flow to the brain.
Surgical shunting is very rare, but if it is required then true brain
pathology exists.. The condition is considered to be "subcompensated"
when the child still has some minor signs or symptoms but is doing okay.
It is "compensated". when there are no clinical signs except
perhaps for a head slightly out of proportion with the rest of the body,
at this point the child expected to be normal.
5) Hypoplasia: Short stature or growth delay without any other medical problems,
usually genetic or "constitutional." Also used to refer to
under-development of any organ such as a limb, the testis, an eye, etc.
6) Hypotrophy: Weight lower than expected for age. May be further described as
mesosomatic or microsomatic, harmonious or dysharmonious, depending on
changes from previous growth and the relationship to the height and
chest circumference.
7) Hypoxia of the
newborn: Lack of oxygen at or before delivery, usually
diagnosed if it was a difficult pregnancy, labor or delivery, if the
baby needed resuscitation at birth or if there was any specific
abnormalities are noted in the placenta or afterbirth. When severe
oxygen deprivation occurred, words like "asphyxia" are used.
"Prenatal hypoxia" is a vague term, sometimes linked with the
wording "non-specific intrauterine infection" to explain away
low weight or asymmetric reflexes or tone in a full term baby.
8) Hypoxic (metabolic)
cardiopathy: A clinical diagnosis, sometimes confirmed by
"metabolic, changes in the EKG." This refers to any number of
mild changes in circulation such as perioral cyanosis (blueness around
the laps or nose), irregular heartbeat, mottled skin, anemia or rickets.
This is a transient condition which resolves when me underlying
condition is treated. Term may be used for more serious conditions such
as myocarditis or infection of the heart.
9) Increased seizure
readiness syndrome: When a child has an evaluation for
suspected seizures or some other problem, an EEG of the brain may be
done. The term is used to describe the finding of an abnormal focus on
the EEG or when a child has increased muscle tone not related to
cerebral palsy. Usually no treatment is given.
10) Minimal brain
dysfunction: Used variably to describe transient
neurologic conditions such as abnormalities in the reflexes or
"soft" neurologic signs such as hyperactivity or short
attention span. It may mean what we in the USA diagnose as ADHD. If
there are any suspicious facial features of fetal alcohol syndrome, this
associated diagnosis will make FAS more likely.
11) Movement (motor)
disorder: This is a result of muscular dystonia, usually
manifested as a delay in gross motor skills. For example, a 10 month old
who cannot crawl has a movement disorder. This is not considered a
serious diagnosis in contrast to more severe forms, pyramidal
insufficiency or spastic tetraparesis. This is a diagnosis that is used
when a child is not "perfect" but no other diagnosis can be
made. Mild developmental delay.
12) Muscular dystonia: Muscle tone is considered to be dependent on the emotional condition of
the baby. A normal child should be calm with appropriate relaxed tone.
Muscular dystonia is present when the tone is very high (jittery or
irritable) or is labile (changes rapidly). This is not a permanent
condition but changes over brief time periods (an hour) as the baby's
state changes (from sleepy to alert, etc.)
13) Oligophrenia: Functional mental impairment, meaning the person is not operating at the
expected intellectual level, this is usually not diagnosed until older
than 4 years. It may be caused by many different conditions such as
genetic disease, head trauma, infection, etc.
Ranges from mild mental delay to severe mental retardation.
Unfortunately, it spans from minimal learning disability to severe
mental retardation.
14) Perinatal
(prenatal) encephalopathy: (Variably translated "perinatal
lesion or affectation of the central nervous system," "encephalopathia,"
and many others.) This is a diagnosis that is given to a newborn when
one or more risk factors are present. Either in the medical history of
the mother or in the baby which may allow for a poor neurological
outcome, but this does not necessarily mean that every baby will have a
poor outcome. It is similar to the rule out diagnosis that we make in
the USA.
Perintal (prenatal) encephalopathy:
Maternal factors:
- Lack of known medical history
- Drug, alcohol or cigarette use
- No prenatal care
- Anemia
- Past miscarriages, abortions or premature deliveries
- Young or old maternal age
- High number pregnancy
- Chronic health problems
- Infections
- Poor social situation
- Difficult or complicated delivery
- Abnormal placenta
Infant factors:
- Low Apgar scores
- Abnormal muscle tone or reflexes
- Jaundice
- Seizures
- Irritability or depression
- Tremor
- Poor suck, feeding problems
- Abnormal head circumference
- Congenital abnormalities
- Genetic conditions
- Abnormal ultrasound of brain or other parts of body
- Intrauterine or perinatal infections
- Prematurity
- Abnormal prenatal growth
- Abnormal laboratory tests
15) Prematurity
Classification: Determined by maternal history and/or a
scoring system such as the Dubowitz (same as used in North America).
Described as stage or degree
Stage or degree Gestational
Age Weight
1
36-37 weeks 2001-2500
grams
2
32-35 weeks 1501-2000
grains
3
28-31 weeks 1000-1500
grams
4
< 28 weeks
< 1000 grams
16) Psycho-affective
respiratory attack: Breath-holding spells. These are of
no medical consequence. If one was to go to a Toys R US in the USA, just
look at the child who did not get the toy that he wanted. He screams and
cries until he turns blue and then he passes out for a second or two.
Parents fear that they were having a seizure, but they actually were
not.
17) Pyramidal
insufficiency. Infant considered to be at risk of
cerebral palsy because of adverse perinatal history (eg, extreme
prematurity or low birth weight) and/or because of abnormal physical
examination (eg, increased tone or reflexes, asymmetry of reflexes,
delayed development). Usually cannot be confirmed as cerebral palsy
until after 12 months of age as some children win improve before then.
Usually is apparent by 6 months of age and, if it is going to resolve,
disappears by 1 year.
18) Rachitis: Rickets, bone disease due to lack of vitamin D.
Stage or degree Time to develop
Clinical signs 1 Weeks Minimal or nothing at all. 2 2-3 months Delayed
development due to bone pain and weakness 3 Many months Marked
developmental delay, bone deformation, abnormal skull shape or size,
poor muscle tone an strength.
19) Spastic
tetraparesis: This is a more serious form movement
disorder in children less than 12 months of age graded from mild to
severe, involving all 4 limbs. In worst case, the child barely moves at
alt. If treatment (massage and physical therapy) is started early, this
usually easily correctable but some children have persistent
neurological findings. If one is to see this diagnosis on the record you
should be very suspicious of cerebral palsy. This is where the video is
important.
20) Stage of
condition: The progression of a disease
A) Recuperation or rehabilitation:
Improving but still requiring treatment.
B) Residual:
Almost recovered but signs or symptoms not completely resolved, expected
to be healthy. Also used for late or permanent results such as
scar or stroke.
C) Recovery Condition: illness
completely resolved.
D) Compensated :
Abnormal but stable.
E) Subcompensated: Abnormal, clinically
unstable, may deteriorate.
By George Rogu M.D.
* 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
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