Medical Professional Publications

What Lab Tests are Needed for Infants Born to Mothers Infected With the Hepatitis C Virus, and When Should They Be Ordered?

Columbus, OH — August 2017

J. Robert Honegger, MDBy J. Robert Honegger, MD, Section of Infectious Diseases, Nationwide Children’s Hospital

Approximately 5 percent of infants born to hepatitis C virus (HCV) infected women acquire the infection from their mothers. It is important to identify HCV-infected infants because they are at risk for late complications of chronic liver disease.

There is some debate about the most efficient and effective testing protocol for HCV-exposed children, but recent reports from several cities indicate that most children vertically exposed to HCV receive no testing at all. Cited reasons include communication breakdowns between mothers, obstetricians and pediatricians; fragmented care; and lack of knowledge about HCV among families and providers. 

The American Academy of Pediatrics (AAP) recommends testing HCV-exposed infants by HCV-antibody at 18 months of age (after loss of transplacentally-acquired maternal antibody). Earlier diagnosis is not medically necessary, though the AAP leaves the door open to use of HCV-RNA PCR testing after 1 month of age if desired. PCR testing before 1 month is known to have poor sensitivity. PCR testing after 1 month of age will likely capture most HCV infected children, but the precise sensitivity of a single PCR in infants has not been determined. 

Given that HCV-exposed infants appear to be at high risk to receive no testing at all, I recommend a combined approach that incorporates early testing by PCR with later antibody testing:

  • Immediately add "perinatal HCV exposure" to problem list

and

  • Test by HCV RNA PCR once at age 2-6 months

and

  • Test by HCV-antibody once at age 18-24 months

Any child found to test positive by PCR or antibody should be referred for evaluation and management.

The Section of Infectious Diseases at Nationwide Children’s has developed a practice tool with more information about the HCV-testing protocol, including a management algorithm.

References:

Kuncio DE, Newbern EC, Johnson CC, Viner KM. Failure to test and identify perinatally infected children born to hepatitis C virus-infected women. Clinical Infectious Diseases. 2016 Apr 15; 62(8): 980-5.

Abughali N, Maxwell JR, Kamath AS, Nwankwo U, Mhanna MJ. Interventions using electronic medical records improve follow up of infants born to hepatitis C virus infected mothers. Pediatric Infectious Disease Journal. 2014 Apr; 33(4): 376-80.

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