Diagnostic Testing

• Infectious diseases (for updates on infectious disease screening, please consult the current AAP Red Book17)
 ○ Hepatitis B surface antigen (HBsAg), hepatitis C antibody (if from country with high prevalence)
 ○ HIV 1 and 2 serologic testing
 ○ Syphilis serologic testing
  • Nontreponemal test (RPR, VDRL, or ART)
  • Treponemal test (MHA-TP, FTA-ABS, or TPPA)
  • For newborn infants, acceptable testing includes biological mother’s prenatal laboratory test results.
  • For children adopted internationally, all testing done before adoption should be repeated.
  • For children adopted internationally, the aforementioned bloodborne pathogen tests should be repeated after placement in the adoptive home for 6 mo.
  • If sexual abuse is suspected, the child should be tested for gonorrhea, Chlamydia, and other sexually transmitted infections. Testing should include any suspected site of abuse, including the mouth and rectum.
 ○ Tuberculosis
  • PPD should be placed on all at risk newly adopted children, including those with previous BCG immunization before placement with the adoptive family.
  • For all children adopted internationally, testing must be repeated after placement in the adoptive home for 6 mo.
   • Children who are anergic because of chronic malnutrition may have a negative initial PPD. PPD also evaluates children who were exposed to active cases of tuberculosis just before placement.
  • Interpretation of positive test results should be consistent with the exposure history and nutritional status of the child, as per the guidelines in the Red Book. Previous BCG immunization before placement should not be considered to be a contraindication to placement of a PPD in any child. A positive PPD should never be assumed to be secondary to the BCG vaccine.
 ○ Stool pathogens should be screened for any child who previously lived in inadequate housing, another country, or an institution or has diarrhea. Diarrhea need not be present for children to have parasite infections.
  • Ova and parasites: 3 tests for optimal screening (48–72 h between collection of each specimen)
   • If available, antigen testing for Giardia and Cryptosporidia species should be obtained.
  • Following treatment of stool parasites, repeat stool studies should be performed to ensure eradication of the parasite.
  • Consider stool bacterial culture if diarrhea is present.
• Anemia, metabolic, and nutritional screening
 ○ Complete blood cell count with red cell indices
     • Routine anemia screening is indicated for all children 6 mo or older, as well as all children adopted internationally.
     • In children with an absolute eosinophil count exceeding 450 cells/mm3 and negative stool ova and parasite examinations, consider serologic testing for Strongyloides and Schistosoma species for children from certain regions.15
 ○ Screening for hemoglobinopathies and blood disorders in children of African, Asian, Hispanic, or Mediterranean ethnicities
  • Sickle cell disease
  • Thalassemia
  • G-6-PD deficiency
 ○ Blood lead concentration for children up to 6 y of age; older ages if indicated (ie, refugees, at-risk cultural practices)
 ○ Newborn screening panel (young infants)
 ○ Rickets screening (calcium, phosphorus, alkaline phosphatase) for children who were institutionalized, have growth delay, or had history of poor vitamin D intake or limited sunlight.
  • Most children are easily treated for this with increased calcium in the diet and a daily multivitamin.
• Testing does not need to be repeated for children adopted from the US foster care system who previously had laboratory studies consistent with the recommendations from the AAP
  • ART, automated reagin test; BCG, bacille Calmette-Guérin; FTA-ABS, fluorescent treponemal antibody absorption; G-6-PD, glucose-6-phosphate dehydrogenase; MHA-TP, microhemagglutination Treponema pallidum; PPD, purified protein derivative; RPR indicates rapid plasma reagin; TPPA, Treponema pallidum particle agglutination; VDRL, Venereal Disease Research Laboratory.