Hepatitis C in newborns may occur if the person who birthed them has acquired infection with the hepatitis C virus (HCV). This happens when an unborn child contracts the infection while in the womb.

However, the Centers for Disease Control and Prevention (CDC) state that the risk of this is very low, at around 4–7%. The CDC also recommends that newborns of people with HCV undergo screening for the virus when they are 1–2 months old. Furthermore, they advise testing for antibodies against HCV after infants are 18 months old.

Many infants with HCV do not have symptoms, but they may grow more slowly and fail to gain weight. The HCV goes away without treatment in approximately 25–50% of infants by the time they reach 4 years of age. For children aged 3 years who still have HCV, there are effective antiviral treatments available.

Keep reading to learn more about the symptoms, diagnosis, and treatment of hepatitis C in newborns.

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Newborn babies have a risk of hepatitis C while in the womb if the person carrying them has contracted the infection. The likelihood is 4–7% per pregnancy, but the risk is higher if the pregnant individual has a high viral load, which is the amount of virus in the blood. There is also a greater likelihood if they develop a coinfection of HIV.

Having a cesarean delivery does not increase the risk.

It is also safe for the person with HCV to breastfeed their infant because no evidence shows transmission can occur in this way. However, if the breastfeeding person has nipples that are cracked and bleeding, they should stop nursing temporarily. Since HCV spreads through blood carrying the HCV infection, it is best to delay nursing until the nipples have healed.

If a male parent or caregiver has HCV, they cannot transmit the virus to a baby in the womb. For this to occur, it would be necessary for them to transmit HCV to the pregnant person first, and then the pregnant person would have to transmit HCV to the baby. The likelihood of such a scenario is close to zero.

Doctors consider HCV a chronic condition in children who still have an HCV infection by the time they are 2 years of age. Most infants with a chronic hepatitis C infection have no symptoms, but their lab tests show may show levels of liver enzymes that characterize this condition.

In addition, infants with HCV may:

  • struggle to gain weight
  • grow more slowly
  • have an enlarged liver or spleen

Most children who acquire HCV when they were a fetus have mild liver disease. Up to 80% have little to no scarring by the time they are 18 years old. However, 20–25% develop a more aggressive form of the disease and may have severe scaring by the time they are 8 years of age.

No recommended treatments are available for children under the age of 3 years. The infection disappears without any medical intervention in approximately 25–50% of infants with hepatitis C.

While doctors do not recommend treatment for infants, they advise HCV screening for all babies born to a mother with the infection. It should consist of RNA testing for HCV after 1–2 months of age, which measures the amount of genetic material from HCV in the blood. It should start at or after 1–2 months of age. It should also involve an antibody-based test, which determines if the body has made proteins that fight HCV. It should not start until infants are 18 months old because up to this time, they have antibodies in the blood from their maternal mother.

In children over 2 years of age, diagnosis involves a two-step procedure: the first step is screening with an antibody test for HCV. Then, if this is positive, doctors use an RNA test for HCV to confirm the diagnosis.

The American Liver Foundation recommends that children with HCV get the vaccine for hepatitis A and B, as well as the yearly flu vaccine. They also advise the below follow-ups:

  • monitoring nutrition and growth
  • measuring the viral load and determining the particular strain of HCV present
  • screening for liver cancer for those with significant liver disease

Another follow-up measure involves testing for the liver enzymes alanine transaminase (ALT) and aspartate transaminase (AST). These levels can sometimes become increased in most children with HCV. Those with high ALT and AST have aggressive liver disease, but others may have an aggressive form of the disease without major elevations of the enzymes.

Once a child reaches 3 years, doctors recommend antiviral treatment, according to a 2020 study. New classes of direct-acting antiviral therapies are highly effective in children, who generally tolerate them well. These medications work by targeting several protein products the HCV makes.

There are reports of complications from chronic HCV in children, but they are not common. They include:

  • portal hypertension, an increase in blood pressure in the vein that transports blood from the digestive organs to the liver
  • ascites, swelling from the presence of fluid in a cavity in the abdomen
  • hepatocellular carcinoma, the term for the most common type of liver cancer
  • variceal bleeding, blood coming from enlarged veins in the food pipe

Learn more about the potential complications of hepatitis C.

When a newborn or child receives a diagnosis of HCV, a parent or caregiver may wish to ask a doctor the following:

  • What are the symptoms to watch for that would indicate a progression of the condition?
  • How long does the child need to take the medication?
  • Does the medication have side effects?
  • Should the child have any activity restrictions?
  • How often should the child have a checkup?

In rare cases, a newborn can have hepatitis C if the individual who birthed the child has the virus and transmits it to the child in the womb. If the pregnant person has a high viral load or HIV, the likelihood is higher.

Because infants with HCV may grow more slowly and have issues gaining sufficient weight, doctors need to monitor their growth and nutrition.

Healthcare professionals do not recommend starting treatment for children younger than 3 years of age. However, after reaching this age, doctors advise starting certain antiviral medications, which are effective and safe.

Most children who acquire HCV while in the womb have mild liver disease. There have been reports of serious complications from HCV in children, such as liver cancer, but they are not common.