Hepatitis C Screening In Newborns With Perinatal Hepatitis C Exposure Discharged From The Regional Perinatal Center Of Western New York Neonatal Intensive Care Unit: A Retrospective Review Of The Past Decade.

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ESPR404
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Background: Hepatitis C virus (HCV) infection  is a growing health risk among children as rates of new HCV infections have been rising since 2010, primarily driven by the current opioid epidemic.1 Perinatal transmission is the most common source of HCV infection in pediatric patients, accounting for >1500 new documented cases per year in US.2 In accordance with the AAP guidelines, children with perinatal exposure to HCV should have Hepatitis C antibody screening at 18 months.There is currently minimal regional tracking of these at-risk infants in Buffalo, NY and screening is largely left to community pediatricians. 

Objective: To assess the degree to which current AAP guidelines regarding follow-up of infants born to HCV positive mothers are being recommended at discharge from the Regional Perinatal Center Of Western New York Neonatal Intensive Care Unit (NICU) in the Buffalo, NY area, and to further examine the demographics of this at risk population.

Method: After institutional IRB review and exemption, we collected and reviewed data of neonates admitted to the Children's Hospital of Buffalo NICU, from 2009 to 2018 with a maternal diagnosis of Hepatitis C. We also reviewed the NICU recommendations for follow-up after discharge, follow-up with the hospital's infectious disease clinic and community pediatricians' offices to evaluate compliance with the recommendations.

Results: There were 101 neonates with maternal history of HCV, who were admitted to the NICU for varying admission diagnosis between 2009 and 2018. Demographics in Table1. 92% of the mothers reported history of illicit substance use. 67% of the infants had documented recommendations and discussions with the community pediatricians regarding follow up at 18 months of age for HCV serologies. 27% of the infants had documented recommendations for HCV testing at various other ages, ranging from 2 months to 12 months. 6% did not have any documented recommendations for follow-up at discharge from the NICU. We have attempted to gather information from the community pediatricians about the timing and results of infant HCV testing but have not succeeded at this point. Only 2% of infants followed up in an infectious disease (ID) clinic for HCV workup. 29% of the infants received breastmilk and 19% were still receiving breastmilk at discharge.

Conclusions: There were gaps in recommending a standardized follow-up timeline for newborns with maternal HCV, and minimal ID clinic follow up when discharged from the NICU. Follow-up test results still need to be followed to determine transmission rate in these patients. Breastfeeding rates in these exposed infants were low. In future, a QI project to standardize the follow-up recommendations and arranging ID clinic appointments in infants with perinatal exposure to HVC will be developed. We intend to create a central database to track follow-up with these infants.

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University at Buffalo
University at Buffalo

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