P0293 FINAL EVALUATION OF A LOOKBACK PROCEDURE TO IDENTIFY HCV INFECTION IN THE TRANSFUSED NICU POPULATION

Abstract

Introduction: Transfusions of blood and blood products were frequently administered to infants admitted to the NICU nursery in the period between 1978–1989 before the identification of the Hepatitis C virus. This lookback study encompasses three distinct time periods between Jan 1978 and Oct 1985 (pre-HIV screening), Nov 1985–Apr 1990 (pre 1st generation HCV testing) and May 1990–Mar 1992 (pre 2nd generation HCV testing) –Periods 1,2 and 3 respectively. Specific aims were to: 1. Determine the incidence and natural history of HCV infection in infants transfused between Jan 1978 and Mar1992. 2. Assess parental awareness of transfusion 3. Examine the efficacy and feasibility of a lookback procedure using various methods of contact (medical records address, provincial health insurance database, provincial archival look-back, provincial laboratory database) Methods: Records from 21,248 (96.9%) of the 21,928 admissions to the two Regional NICU’s in Edmonton were reviewed for transfusions. A package including a requisition for HCV Ab and PCR testing and a questionnaire regarding knowledge of transfusion and its associated risks was mailed to identified transfused infants’ caregivers using the methods of contact above. Results: 7590 (36%) of the infants were transfused. Results are now expressed according to Periods 1, 2 and 3. Transfused neonates decreased over time from 42.4% to 29.9% to 19.4%. The transfused group had significantly higher in-hospital mortality proportions than the non-transfused group (14.4%, 16.4%, 17.2% vs 3.6%, 2.5%, 5%). Awareness of transfusion was 46.3%, 51.2% and 60.1%. Successful testing responses were 31.5%, 48.8% and 45.2%. Of children tested for HCV Ab, 17 (1.5%), 12 (1.5%) and 1 (0.4%) children were positive and 3 subjects in each of periods 1 & 2 were HCV-indeterminate. The rate of Hepatitis C PCR positivity in the whole group positive for HCV antibody was 67%. Crude per donor risks of HCV in the three periods were 0.0027, 0.0028 and 0.0005 respectively. Conclusion: Transfusions decreased over time in both NICU’s, but transfused infants had significantly higher in-hospital mortality than non-transfused infants. Parental awareness of transfusion increased over time, as did successful testing for HCV Ab. The rate of HCV infection in the NICU’s was 1.5% for the period prior to the introduction of 1st generation HCV Ab testing, and decreased thereafter, as did crude per donor HCV risk. The rate of PCR positivity in our group of HCV positive patients was 67%. We acknowledge the support of CIHR, MRC, Canadian Blood Services, the Canadian Red Cross Society and the Children’s Health Foundation of Northern Alberta.