How should you manage children born to hepatitis C-positive women?
Defer postpartum lab testing
Because about 20% of infants exposed to HCV clear the virus spontaneously, and maternal antibodies can confound laboratory results, deferring postpartum diagnostic testing is appropriate. A study of 1104 children in whom vertical transmission didn’t occur after exposure to HCV showed that 95% of the children were anti-HCV antibody negative by 12 months age.6 A prospective study of 23 infants documented spontaneous clearance of HCV RNA by 6 months in all patients.7
Recommendations
The National Institutes of Health 2002 Consensus Statement recommends:8
- avoiding fetal scalp electrodes and prolonged rupture of membranes
- serum testing for HCV RNA at 2 months and 6 months of age
- anti-HCV antibody testing after 15 months of age.
The American College of Obstetricians and Gynecologists supports breastfeeding, recommends against routine HCV screening, and recommends that cesarean delivery be reserved for obstetric indications.9
The American Association for the Study of Liver Diseases recommends serum testing and liver biopsy on the same schedule as adult patients and endorses considering treatment after 3 years of age.6
The US Food and Drug Administration has approved treatment after 3 years of age for children with detectable HCV RNA levels higher than 50 IU/mL and who have had a liver biopsy with portal or bridging fibrosis and at least moderate inflammation and necrosis.
The American Gastroenterological Association recommends considering treatment with PEG-interferon and ribavirin after 3 years of age.10
Acknowledgements
The opinions and assertions contained herein are the private view of the authors and not to be construed as official, or as reflecting the view of the US Air Force Medical Service or the US Air Force at large.
