From the Guidelines
For a newborn with an HCV positive mother, testing should be performed when the child is 18 months of age using an anti-HCV antibody test, as recommended by the American Academy of Pediatrics and CDC 1. This approach is based on the fact that passive transfer of HCV antibody from mother to child occurs and can persist for up to 18 months of age, leading to potential false positive results if tested earlier 1. Some key points to consider in the management of a newborn with an HCV positive mother include:
- Breastfeeding is considered safe and should not be discouraged as HCV is not efficiently transmitted through breast milk, according to the EASL clinical practice guidelines 1.
- Cesarean section is not routinely recommended solely to prevent transmission, as it does not decrease perinatal transmission of HCV 1.
- The infant should receive routine immunizations, including hepatitis B vaccine.
- No antiviral treatment is recommended for the newborn unless chronic infection is confirmed.
- Regular follow-up with a pediatrician is important, and if the child tests positive for HCV, referral to a pediatric gastroenterologist or infectious disease specialist is recommended for potential treatment, which is highly effective and can be initiated once the child is older. It is essential to note that the risk of vertical transmission is relatively low, approximately 5-6%, and primarily occurs during delivery 1. Therefore, no specific preventive measures are needed at birth, and the focus should be on monitoring the child's health and providing appropriate testing and treatment if necessary.
From the Research
Newborn with HCV Positive Mother
- The primary concern for a newborn with an HCV positive mother is the risk of vertical transmission of the virus, which can occur during pregnancy or delivery 2.
- According to the CDC, approximately 6%-7% of perinatally exposed infants and children will acquire HCV infection 3.
- The risk of transmission is influenced by maternal virus load, although the levels of viremia cannot be used as predictors of pediatric infection in individual cases 2.
Screening and Follow-up Recommendations
- The CDC recommends HCV testing of all perinatally exposed infants with a nucleic acid test (NAT) for detection of HCV RNA at age 2-6 months 4, 3.
- Infants with detectable HCV RNA should be considered infected if viremia is confirmed by a second assay performed within the 12th month 2.
- Perinatally exposed infants and children with an undetectable HCV RNA result at or after age 2 months do not require further follow-up unless clinically warranted 3.
- A NAT for HCV RNA is recommended for perinatally exposed infants and children aged 7-17 months who previously have not been tested, and a hepatitis C virus antibody (anti-HCV) test followed by a reflex NAT for HCV RNA (when anti-HCV is reactive) is recommended for perinatally exposed children aged ≥18 months who previously have not been tested 3.
Challenges in Screening and Follow-up
- One of the major challenges in achieving global eradication of HCV is reducing underdiagnosis, which is mainly due to the cost of molecular tools and the mild clinical symptoms observed in HCV chronic disease 5.
- Many perinatally infected children are not tested or linked to care, highlighting the need for improved screening and follow-up strategies 3.
- A study found that follow-up at 18 months postdelivery from an HCV viral load positive mother occurs in less than half of the cases, emphasizing the need for alternative screening strategies 6.