The first role of primary care doctors, such as pediatricians, is preventing sickness and accidental harm. Screening, and when possible, treating early is an important part of prevention.
The word “bilious” can mean distasteful, spiteful. Ancients used it describing a person with liver inflammation who had become yellow/green. Liver inflammation (hepatitis) can be caused by chemicals (alcohol), toxins, some medications, certain medical conditions and viruses.
In the US the most common hepatitis viruses are hepatitis A, B and C. There are vaccines to prevent hepatitis A and B but not C (HCV). There are no curative treatments for A or B but there are medicines to cure 95% of HCV. HCV is usually described as “acute” meaning a new infection or “chronic” meaning a continuing infection. While the acute phase only last a few weeks greater than 50% end up with a chronic infection just because they’re not treated. The chronic infection is a silent disease which can lead to liver damage and failure, cirrhosis, liver cancer and even death. It is the most common cause for liver transplants in the US.
HCV is spread when someone comes in contact with infected blood. This could be with the sharing of needles, syringes but also nail clippers, razors, tooth brushes, glucose monitors or other items that may have come in contact with infected blood. Approximate 6% of infants born to infected mother will become infected.
Untreated children and adolescents recover from the acute phase of HCV but 60-80% develop chronic infections that can lead to serious liver problems and possibly death. The U.S. Centers for Disease Control and Prevention recommends that women get tested for HCV with every pregnancy. If the mother is positive and the baby is exposed, the infant should be tested with a special kind of blood test that detects HCV RNA and can tell if the infant has been infected in the last 1-2 weeks. This test should be done at 2-6 months of age. If the infant test positive for exposure they should be referred to an expert in pediatric hepatitis C for appropriate evaluation and the opportunity to provide curative, life-saving treatment. If the infant test negative for the HCV RNA no further follow up is needed.
The CDC has noted that the rate of HCV infections is increasing possibly secondary to the opioid crisis. Screening for HCV infections with each pregnancy is recommended but is far less than 100%. Unfortunately many infants exposed at birth are not being tested for HCV. This may be because of lack of awareness of their exposure by their pediatric health care providers and/or the lack of regular prenatal and pediatric care. The change of the recommended testing age from 18 months to 2 months is to prevent the loss of follow up by including the testing when most infants are being screened and immunized.
Prevention is primary and cost saving.
Also See:
UTMB Pediatrics - Pediatric Primary Care
UTMB After Hours Urgent Care
UTMB Clear Lake Hospital - Pediatric ER & Inpatient Unit