Published online October 5, 2009
PEDIATRICS Vol. 124 No. 5 November 2009, pp. e1007-e1013 (doi:10.1542/peds.2009-0567)

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SPECIAL ARTICLE

Recommendations for Screening, Monitoring, and Referral of Pediatric Chronic Hepatitis B

Barbara A. Haber, MD^a, Joan M. Block, RN, BSN^b, Maureen M. Jonas, MD^c, Saul J. Karpen, MD, PhD^d, W. Thomas London, MD^e, Brian J. McMahon, MD^f, Karen F. Murray, MD^g, Michael R. Narkewicz, MD^h, Philip Rosenthal, MDⁱ and Kathleen B. Schwarz, MD^j

^a Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
^b Hepatitis B Foundation, Doylestown, Pennsylvania
^c Division of Gastroenterology, Children's Hospital Boston, Boston, Massachusetts
^d Department of Pediatrics/Gastroenterology, Hepatology, and Nutrition, Baylor College of Medicine, Houston, Texas
^e Fox Chase Cancer Center, Philadelphia, Pennsylvania
^f Liver Disease and Hepatitis Program, Alaska Native Medical Center, Alaska Native Tribal Health Consortium, Anchorage, Alaska
^g Division of Gastroenterology, Hepatology, and Nutrition, Seattle Children's and University of Washington School of Medicine, Seattle, Washington
^h Department of Pediatrics, Section of Pediatric Gastroenterology, Hepatology, and Nutrition and Pediatric Liver Center, University of Colorado Denver School of Medicine and Children's Hospital, Aurora, Colorado
ⁱ Pediatric Hepatology, University of California, San Francisco, California
^j Pediatric Liver Center, Division of Pediatric Gastroenterology and Nutrition, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland

Most children with chronic hepatitis B virus infection (persistent hepatitis B surface antigen–positive for >6 months) are asymptomatic and do not generally require treatment. These children are, however, at increased risk for severe complications later in life, including advanced liver disease and liver cancer. On November 11, 2008, the Hepatitis B Foundation, a nonprofit research and disease advocacy organization, convened a panel of nationally recognized North American pediatric liver specialists to consider and recommend an approach for the screening, monitoring, initial management, and referral of children with chronic hepatitis B. The panel developed recommendations to provide guidance to practitioners on determining what additional tests to conduct, how often to monitor on the basis of test results, and when to refer to a pediatric liver specialist to build a partnership between the practitioner and liver specialist to enhance the success of management of children with this lifelong infection.

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Key Words: hepatitis B • chronic • pediatrics • screening • disease management • liver

Abbreviations: HBV—hepatitis B virus • HCC—hepatocellular carcinoma • HBsAg—hepatitis B surface antigen • anti-HBs—antibody to hepatitis B surface antigen • ALT—alanine aminotransferase • HBeAg—hepatitis B e-antigen • anti-HBe—antibody to hepatitis B e antigen • ULN—upper limit(s) of normal • CDC—Centers for Disease Control and Prevention • AFP—-fetoprotein

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Accepted Aug 7, 2009.

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