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Wednesday, April 16, 2014
Newborn and Infant Care
My Wife and I are condsidering adopting a 17 month old "special needs" boy from China. When he was found, he was Diagnosis with congenital heart defect(atrial septal defect and ventricular septal defect), high pressure in pulmonary artery, and chronic bronchitis. He has had surgery to repair his heart which we were told was successful. Although he is now said to be fine, his head circumference at 10 months old was 40.9 cm and is currently (at 17mos old) is 43cm.
Should this be a cause for concern??
There are several factors you should consider in this situation. First, his head circumference is low enough that the diagnosis of microcephaly should be entertained. Microcephaly is a failure of brain development that can have several causes; some treatable (with varying outcomes) and others that will require supportive care throughout his lifetime. However, if his height and weight are also delayed, this may be a result of his heart and lung conditions. Either way, he is extremely small for his age and this requires serious consideration.
Second, even though his congenital heart defects have been surgically corrected, that is not to say that his heart does not have residual problems. Some may be apparent now, some may become more pronounced with growth.
Finally, I am concerned that he may have some lung issues, possibly related to his heart problems. Chronic bronchitis is not a term commonly used with children. Has he developed a chronic condition that will require ongoing support for adequate breathing?
Additional information that may help you decide if this child's condition overly complex:
- Was he premature?
- What do we know of his birth history?
- Did his mother receive any prenatal care?
- Did he require a mechanical ventilator at or shortly after birth?
- Has he required oxygen therapy for prolonged periods?
- Is he developmentally delayed? How has this been assessed?
If you have this, or any, additional information, I would recommend an appointment with your pediatrician or with a pediatric international adoption specialist (if available in your area) to review the history you do have. Your decision to adopt a child with special needs is to be applauded, but going into the situation as fully informed as possible is of great importance.
Sarah Sauntry, RN, MS, CPNP-PC
Assistant Professor of Clinical Nursing
College of Nursing
University of Cincinnati