Referral guideline – Hepatitis C diagnosis and management of the newborn

Introduction

  • Hepatitis C infection in the newborn is most commonly transmitted vertically from the mother, occurring either intrauterine or intrapartum.
  • The majority of babies with HCV infection are asymptomatic, with hepatomegaly and/or mild transaminitis occasionally seen.
  • There is currently no approved treatment for neonates/children with HCV infection in Australia. Despite this, if a baby is found to have HCV infection or is HCV antibody positive at 18 month of age referral to a Paediatric Gastroenterologist is important for definitive diagnosis and long term follow up if required.
  • This guidelines is specific to Queensland. Recommendations in other states may vary.

GP management

For all babies born to mothers who are HCV Positive: Test the infant at 12-18 months of age: HCV antibody + Liver Function Tests

  • Note: HCV antibody testing earlier than 12-18 months is of limited value due to passive transfer of maternal antibodies. In cases of significant parental anxiety due to this delay, or following a high risk delivery (e.g. traumatic birth/significant blood loss), HCV viral load (HCV RNA PCR) can be performed any time after 3 months of age.
  • Note: HCV RNA PCR testing may incur out of pocket costs. Viral load tests are blood tests that measure HCV ribonucleic acid (RNA, or genetic material) in the blood. The presence of viral RNA indicates that the virus is actively replicating (reproducing and infecting new cells). A viral load test is usually first done after a person has tested positive for exposure to HCV based on an antibody test.

When to refer

  1. HCV antibody positive at 12-18 months: refer to LCCH Gastroenterology Department for further testing to determine status.
  2. HCV antibody negative at 12-18 months: The baby has not contracted Hepatitis C and requires no further follow up.
  3. HCV RNA PCR positive – refer to LCCH Gastroenterology.
  4. HCV RNA PCR negative – no further follow up.

Essential referral info

  • All pathology results (specifically HCV antibody, HCV RNA PCR if done, + LFTs)
  • Length and Weight
  • Presence or absence of jaundice
  • Report whether liver and/or spleen palpable
  • Patient details
  • Medicare number
  • Parent/carer name and contact details
  • Referring clinician details (name, contact details, provider number, date and length of referral)

Helpful referral info

  • Medical history including any co-morbidities
  • Family history of liver disease
  • Allergies

Parent service

Gastroenterology, Hepatology and Liver Transplant

Contact details

Hospital Switchboard
(Ask for the Gastroenterology Registrar)
t: 07 3068 1111