Outcome of Infants Born to Hepatitis C Infected Women

Abstract

Hepatitis C virus (HCV) may be transmitted from mother to infant either during late pregnancy or at the time of delivery. Outcomes were studied in 314 infants born to 296 HCV-positive women in the years 1994-1999. The infants were monitored prospectively from birth for as long as 52 months and for a median time of 18 months. The study infants were bom at a median gestational age of 39 weeks and had a median birth weight of nearly 3 kg; 40% were below the 10th centile for body weight. Neonatal abstinence syndrome requiring treatment developed in 46% of infants. None of the three deaths appeared to result from HCV infection. Infection was documented in 11 of 173 infants evaluated. Four infants had HCV RNA detected on a single occasion. The vertical transmission rate was 6.4%. Infection was diagnosed at a median age of 3 months. Liver transaminases were elevated in 8% of uninfected infants. Although a negative result on an HCV polymerase chain reaction (PCR) test before age 1 month did not rule out infection, all infected infants had HCV RNA detected when next examined at age 2 to 10 months. In no case was there significant exposure to blood or body fluids that made postnatal transmission unlikely. Antibody responses waned at age 3 to 6 months in a majority of infected infants, and without PCR testing, this observation could have been incorrectly ascribed to seroreversion. Three infants had an enlarged liver. All those infected had elevated liver transaminase levels but normal bilirubin levels. One infant developed acute hepatitis at age 6 months but had a favorable course. Another had liver biopsy changes of mixed inflammation, piecemeal necrosis, and mild fibrosis; HCV RNA subsequently became undetectable. None of the infants have yet received specific anti-HCV treatment. None are infected by HIV. Of the 162 uninfected infants, 77% seroconverted by age 12 months; the median age was 9 months. No late seroconversion has been noted. Thirteen of these infants had transient liver transaminase elevations unrelated to intercurrent illness; in one instance the elevation persisted at 32 months, but no cause was found. The authors propose, as a minimum monitoring schedule for HCV-exposed infants, that HCV PCR and transaminase estimates be repeated at age 6 to 8 weeks, HCV PCR and antibody testing at 6 months, and final testing at 18 months to confirm seroreversion and detect any late seroconversion.