Although hepatitis C predominantly affects adults, the infection also sometimes occurs in babies. The virus is the same, but there are some important differences between hepatitis C infections in babies compared to adults. The route of transmission, course of the infection, and testing and treatment recommendations differ. Babies with hepatitis C are generally well, however, and daily life is much like that with any other infant, with a few relatively minor adjustments.
Source of Infection
Nearly all babies infected with the hepatitis C virus, or HCV, contract the infection from their HCV-positive mothers. The virus passes from an infected mother to her baby during pregnancy or at the time of delivery. In the United States, approximately 7,500 babies contract hepatitis C through this route each year, according to the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition, or NASPGHAN. However, most babies born to mothers with HCV do not become infected. Roughly 6 out of 100 babies born to HCV-positive mothers contract the infection, according to a study reported in September 2014 in "Clinical Infectious Diseases." The risk of infection nearly doubles if the mother has both HCV and HIV.
Diagnosis and Testing
The American Academy of Pediatrics recommends hepatitis C screening for all children born to mothers with HCV. Two tests can be used to diagnose hepatitis C in babies. The HCV-RNA test checks for the presence of the virus in the bloodstream. This test can be used to diagnose hepatitis C in babies beginning at 2 months of age, according to NASPGHAN recommendations. A positive HCV-RNA test indicates the baby is HCV-infected. For babies older than 18 months, a screening test is usually performed first. It detects immune system proteins against the hepatitis C virus, known as anti-HCV. If the anti-HCV test is positive, then the HCV-RNA test is performed to confirm the diagnosis of current hepatitis C infection.
Early Health Concerns
Babies born with HCV are typically healthy. Liver function is normal, although some babies might have liver swelling. Uncommonly, HCV-infected babies don't gain weight as quickly as expected. Babies infected with HCV from birth have a higher likelihood of clearing the virus without treatment, compared to those who contract the virus later in childhood or adulthood. Approximately 25 to 40 percent of these HCV-infected babies spontaneously clear the infection, according to NASPGHAN. In adults, the rate of spontaneous HCV clearance is only 15 to 25 percent, according to the Centers for Disease Control and Prevention. HCV in babies typically clears by 2 years of age, but clearance may occur as late as age 7.
According to the American Academy of Pediatrics, mothers with HCV can safely breastfeed their babies -- regardless of whether the baby is also infected. If the nipples are cracked or bleeding, however, refraining from breastfeeding until they have healed may be recommended. Caring for a baby with hepatitis C is much the same as caring for any other infant. The only extra precautions involve dealing with blood from accidental injuries. Cuts and scrapes should be covered with a protective bandage, and blood should be cleaned from surfaces with a 10 percent household bleach solution while wearing protective gloves.
As with other infants, babies with HCV require routine healthcare visits to track their growth and development, and receive recommended childhood immunizations. Babies with HCV also need to be monitored with periodic blood tests to determine whether the infection spontaneously clears. If the infection persists into toddlerhood and beyond, ongoing monitoring is recommended at least yearly to check for signs of liver damage. NASPGHAN recommends against treating children younger than 3 years old with hepatitis C medications because there is a good chance for natural HCV clearance, and the infection generally causes no significant harm in young children. Additionally, as of 2015, newer hepatitis C medicines called direct-acting antivirals are not yet approved for use in children.
Medical advisor: Tina St. John, M.D.