MAT HEP C X NN

 A

Neonatal Management of Maternal Hepatitis C (HCV) Exposure

1. Perinatal Transmission Risk

• Vertical transmission occurs in 5-6% of cases, increasing to 10-15% if the mother is co-infected with HIV.

• No proven strategies to reduce transmission risk at birth.

2. Delivery Considerations

• Mode of Delivery: Routine C-section not recommended unless obstetric indications exist.

• Avoid fetal scalp monitoring and prolonged rupture of membranes to minimize transmission risk.

3. Postnatal Care of the Neonate

• Breastfeeding: Safe unless the mother has cracked/bleeding nipples.

• Isolation Precautions: Standard precautions only—no additional isolation required.

• Hepatitis B and HIV Testing: If maternal co-infection is suspected, follow standard protocols.

4. Diagnostic Testing in the Infant

• HCV RNA (PCR):

  • Can be tested ≥2 months (earlier testing may have false positives).

  • If negative at 3 months, repeat at 6 months to confirm clearance.

• Anti-HCV Antibody:

  • Not useful before 18 months due to transplacental maternal antibodies.

  • If positive at 18 months, indicates chronic infection.

5. Follow-up and Long-term Care

• If HCV RNA positive, refer to pediatric hepatology for monitoring and potential treatment.

• Direct-acting antiviral (DAA) therapy is not currently approved for children <3 years but may be considered in older children.

• Monitor liver function and screen for hepatobiliary complications.

Would you like an infographic for this?

A

A

Direct-Acting Antiviral (DAA) Therapy for Pediatric Hepatitis C

1. Indications for Treatment

• Recommended for children aged ≥3 years with chronic HCV infection (HCV RNA positive).

• Goal: Achieve sustained virologic response (SVR) and prevent long-term liver damage.

2. FDA-Approved DAA Regimens in Pediatrics

Age Group	Preferred DAA Regimen	Duration	Genotypes Covered	Notes
≥3 years	Sofosbuvir + Ledipasvir (Harvoni)	12 weeks	GT 1, 4, 5, 6	For children ≥17 kg
≥3 years	Sofosbuvir + Ribavirin	12–24 weeks	GT 2, 3	Weight-based Ribavirin dosing
≥12 years	Glecaprevir + Pibrentasvir (Mavyret)	8 weeks	All genotypes (1-6)	No Ribavirin needed
≥12 years	Sofosbuvir + Velpatasvir (Epclusa)	12 weeks	All genotypes (1-6)	Pan-genotypic

3. Monitoring During Therapy

• Baseline: HCV genotype, liver function tests (LFTs), HCV RNA, renal function.

• During Therapy: Monitor adherence and side effects (minimal with DAAs).

• Post-Treatment (12 weeks after completion): HCV RNA to confirm SVR (cure).

4. Contraindications & Considerations

• DAAs not approved for children <3 years.

• Ribavirin-containing regimens require hemoglobin monitoring due to risk of anemia.

• Avoid co-administration with certain anticonvulsants and rifampin due to drug interactions.

Would you like a visual summary or infographic for this?

A