Hepatitis C infection in children who received extracorporeal membrane oxygenation

Abstract

Objective: To determine the prevalence of antibody to hepatitis C virus (HCV) in a cohort of neonates who received extracorporeal membrane oxygenation (ECMO) therapy, and to determine risk factors associated with seropositivity. Design: Eighty-three patients who had been treated with ECMO as neonates (from August 1986 through January 1992) at Children's Hospital, Boston, were tested for antibodies to HCV. The medical records were reviewed, and information regarding neonatal history was obtained. Anti-HCV seronegative and seropositive children were compared using univariate and multivariate analyses. Results: Seven patients (8%) were anti-HCV seropositive. Of the seven seropositive children, four (57%) currently have ALT values of more than 1.5 times the upper limit of normal; only five of the 52 (9.6%) seronegative patients have values this high ( P < .001). Patients in the seropositive group had received blood screened by “surrogate markers” (6 of 50) or by ELISA-1 anti-HCV testing (1 of 33). Significant differences between the seropositive and seronegative patients were found with respect to the aminotransferase and bilirubin levels during the initial ECMO hospitalization. The last ALT value before discharge was the only significant predictor of HCV infection in the multivariate model. Conclusion: Neonates treated with ECMO are at risk for the development of HCV infection. Neonates who received blood products from donors screened by surrogate markers or ELISA-1 anti-HCV testing should be considered at risk. Neonates who had an abnormal ALT value at the time of discharge are most likely to be anti-HCV seropositive.