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Expert Panel of Pediatric Liver Specialists Publishes Recommendations for Monitoring and Referral of Children With Chronic Hepatitis B Infections
Date:10/5/2009

niversity School of Medicine, panel member and a co-author of the report. Schwarz stressed, however, that "this is a progressive disease, and children infected chronically with HBV have an increased risk of severe complications as teens or adults, including cirrhosis, and even liver cancer. This is why screening and identification of HBV infection in children is essential."

A challenge facing pediatricians is the lack of clear screening, monitoring and treatment guidelines.

"There are several national and international guidelines available regarding the management of adults with chronic HBV infection," said Brian McMahon, M.D., of the Alaska Native Tribal Health Consortium, panel member and a co-author of the report, "but guidelines for the treatment of children are still evolving, in part because of the limited number of drugs that have been studied in children so far. In the absence of guidelines, the best approach for children is for the primary care physician and a pediatric liver specialist to work in partnership to develop an individualized treatment plan to manage this life-long chronic infection."

"Many children end up at a pediatric liver specialist as a result of parental advocacy," Dr. Haber said. "There needs to be a greater focus on routinely identifying and referring children with chronic HBV."

The panel's report provides recommendations for primary care providers on the initial management of these children, including what tests to conduct to periodically monitor disease progression, and when, based on the test results, a pediatric liver specialist should be consulted. The report includes a flow chart outlining the recommendations, which cover liver function testing, hepatitis B serology and DNA levels, liver ultrasound, alpha-fetoprotein (AFP) testing, and family history. The panel advocates for referral of any child with elevated serum liver enzyme levels, elevated AFP levels, or a family history of liver d
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SOURCE Hepatitis B Foundation
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