P3C138: Hepatitis C Exposure Diagnosis and Testing in Infants Born to Hepatitis C Virus Infected Mothers

Background: The incidence of hepatitis C virus (HCV) infection has risen in recent years, primarily driven by injection drug use. In women of childbearing age, infection rates doubled from 2006 to 2014. As a blood-borne disease, HCV carries a risk for vertical transmission. Infants born to women infected with HCV tend to be smaller for their gestational age and require Neonatal Intensive Care Unit (NICU) admission and ventilation more often than their counterparts. The North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) recommends testing children born to HCV infected mothers at 18 months with anti-HCV antibody testing or serum HCV RNA after two months of age. Studies suggest that exposed infants are not being adequately tested for HCV. This study aimed to determine whether infants exposed to HCV in utero had prenatal HCV exposure documented in electronic health records (EHR) and if they were adequately tested for HCV after birth.

Methods: A retrospective review of infants born in a tertiary urban hospital in NJ from 1/1/2011 to 1/1/2021. Records of infants born to mothers with prenatal diagnosis of HCV were examined to determine whether they were documented to have HCV exposure in EHR. Infants with perinatal HCV exposure were evaluated to determine if anti-HCV antibody testing at 18 months or serum HCV RNA after two months of age was performed. Infants who received the exposure in EHR but were lost to follow-up prior to two years of age and not tested in that time period were excluded. General maternal and neonatal clinical and demographic data was analyzed.

Results: Of the 142 mothers with prenatal diagnosis of HCV, 114 (80%) infants had a diagnosis of HCV exposure in the EHR. Of the HCV exposed infants with follow-up data by 24 months of age, 52 (46%) were tested with 34 out of 52 (65%) receiving adequate testing. Infants documented as HCV exposed were more likely to be born to a mother with non-opioid drug use in pregnancy (p=0.01) and have a higher birth weight (p=0.03). Of tested infants, those with a higher number of well child pediatrician visits (p=0.01) were more likely to receive adequate testing. Adequately tested infants were significantly more likely to receive HCV antibody testing when compared to those not tested adequately (p=0.02).

Conclusion: A significant proportion of infants born to HCV-infected mothers were either not identified at birth (20%) or did not receive appropriate testing on follow-up (35%). Further work needs to be done to improve documentation of HCV exposure at birth and follow-up testing in order to avoid missing congenitally acquired HCV.