Do elective cesareans cut perinatal hepatitis C? (Panel calls for research).

BETHESDA, MD. -- An expert panel has called for research into the possibility that elective cesarean section may protect against perinatal transmission of hepatitis C infection.

Acquisition of the infection through the maternal-infant route has assumed new importance, now that improved screening has virtually eliminated transfusion-associated hepatitis C in children, Perinatally acquired hepatitis C is expected to become the most common type of childhood hepatitis within a few years, participants agreed at a consensus development conference on the disease sponsored by the National Institutes of Health.

Currently, there are an estimated 240,000 exposed or infected children in the United States, many of whom have not yet been identified. "HCV infection in children is not rare, and it is under-recognized. The primary target for prevention strategies should be perinatal transmission," said Dr. Maureen M. Jonas of the Center for Childhood Liver Disease at Children's Hospital, Boston.

Children with perinatally acquired HCV typically show elevated ALT levels, which indicate hepatic injury, for a few years. With time, ALT levels usually normalize and patients have only mild or absent signs and symptoms, even though the infection persists and continues to damage the liver.

In some cases, the pediatric infection takes an aggressive course and leads to cirrhosis and end-stage liver disease during childhood, said Dr. Jonas, also of Harvard Medical School, Boston.

Dr. Eve A. Roberts said that little is known about perinatal transmission, partly because widely differing study designs have yielded conflicting results. Defining the disease itself is complicated in infants, as some of them may have transient viremia without genuine infection, and others may have acute self-limited infection ...