Hepatitis C in newborns: Symptoms, diagnosis, and treatment

Hepatitis C in newborns can occur if the person who gave birth to them has contracted hepatitis C virus (HCV) infection. This happens when an unborn child gets the infection in the womb.

However, the Centers for Disease Control and Prevention (CDC) state that the risk of this is very low, around 4-7%. The CDC also recommends that newborns of people with HCV be screened for the virus when they are 1-2 months old. In addition, they recommend testing for antibodies to HCV after babies are 18 months old.

Many babies with HCV have no symptoms, but they may grow more slowly and not gain weight. The HCV disappears without treatment in about 25-50% of infants by the time they reach 4 years of age. Effective antiviral treatments are available for children as young as 3 years old who still have HCV.

Keep reading to learn about the symptoms, diagnosis, and treatment of hepatitis C in newborns.

Newborn babies are at risk for hepatitis C in the womb if the person carrying them has contracted the infection. The chance is 4-7% per pregnancy, but the risk is higher if the pregnant woman has a high viral load, the amount of virus in the blood. There is also a higher chance if they develop a co-infection of HIV.

Having a cesarean section does not increase your risk.

It is also safe for the person with HCV to breastfeed their baby as there is no evidence that transmission can occur this way. However, if the breastfeeding person has cracked and bleeding nipples, they should temporarily stop breastfeeding. Since HCV spreads through blood carrying the HCV infection, it is best to postpone breastfeeding until the nipples have healed.

If a male parent or caregiver has HCV, they cannot transmit the virus to a baby in the womb. For this to happen, they would need to pass HCV to the pregnant person first, and then the pregnant would have to pass HCV to the baby. The probability of such a scenario is almost zero.

Doctors consider HCV to be a chronic condition in children who still have an HCV infection by age 2 years. Most babies with chronic hepatitis C infection have no symptoms, but their lab tests show that they may show levels of liver enzymes that are characteristic of this condition.

In addition, infants with HCV may:

have trouble gaining weight grow more slowly have an enlarged liver or spleen

Most children who received HCV when they were a fetus have mild liver disease. Up to 80% have little to no scars by the time they are 18 years old. However, 20-25% develop a more aggressive form of the disease and may have severe anxiety by the time they are 8 years old.

There are no recommended treatments available for children under 3 years of age. The infection clears up without medical intervention in about 25-50% of infants with hepatitis C.

While doctors don’t recommend treating infants, they do recommend HCV screening for all babies born to a mother with the infection. It should consist of RNA testing for HCV after 1-2 months of age, which measures the amount of genetic material of HCV in the blood. It should start at or after the age of 1-2 months. It should also include an antibody-based test, which determines whether the body has made proteins that fight HCV. It shouldn’t start until babies are 18 months old because they have antibodies in their mother’s blood until now.

In children older than 2 years, the diagnosis involves a two-step procedure: the first step is screening with an antibody test for HCV. If positive, doctors use an RNA test for HCV to confirm the diagnosis.

The American Liver Foundation recommends that children with HCV receive the hepatitis A and B vaccine, as well as the annual flu vaccine. They also recommend the follow-ups below:

monitoring nutrition and growth measuring viral load and determining specific HCV strain liver cancer screening for people with significant liver disease

Another follow-up measure is testing for the liver enzymes alanine transaminase (ALT) and aspartate transaminase (AST). These levels can sometimes rise in most children with HCV. Those with high ALT and AST have aggressive liver disease, but others may have an aggressive form of the disease without large elevations in enzymes.

Once a child turns 3, doctors recommend antiviral treatment, according to a 2020 study. New classes of direct-acting antiviral therapies are highly effective in children, who generally tolerate them well. These drugs work by targeting different protein products that the HCV makes.

There are reports of complications of chronic HCV in children, but they are uncommon. They contain:

portal hypertension, an increase in blood pressure in the vein that carries blood from the digestive organs to the livers, swelling due to the presence of fluid in a cavity in the abdomen hepatocellular carcinoma, the term for the most common form of liver cancer varicose veins, blood comes from enlarged veins in the food pipe

Read more about the potential complications of hepatitis C.

When a newborn or child is diagnosed with HCV, a parent or caregiver may ask a doctor:

What are the symptoms to watch out for that indicate progression of the condition? How long should the child take the medication? Does the medication have side effects? Should the child have activity restrictions? How often should the child be checked?

In rare cases, a newborn can have hepatitis C if the person who gave birth to the child has the virus and passes it on to the child in the womb. If the pregnant woman has a high viral load or HIV, the risk is higher.

Because infants with HCV may grow more slowly and have trouble gaining sufficient weight, doctors should monitor their growth and nutrition.

Healthcare professionals do not recommend starting treatment for children under 3 years of age. However, after reaching this age, doctors advise starting certain antiviral medications, which are effective and safe.

Most children who receive HCV while in the womb have mild liver disease. There have been reports of serious complications of HCV in children, such as liver cancer, but these are uncommon.

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