Background: Infection with the hepatitis C virus (HCV) affects 2%-3% of the world's population. Egypt has the highest
recorded prevalence of HCV in the world, reaching 14.7% for HCV-antibody (Ab) positivity among 15- to 59-year-olds in
2008. The natural history of vertically acquired HCV in children is uncertain, with the majority (73–92%) suffer continual
infectious state but stay asymptomatic in the first few years.  Aim: To investigate the diagnostic performance and characteristics of maternal HCV RNA testing in predictability of developing neonatal positive HCV Ab and positive HCV RNA.  Methodology: At Benha University hospital from 2016 to 2018 Obstetrics and Gynecology department in collaboration with Hepatology, Gastroenterology and infectious disease department, HCV RNA +ve pregnant women were recruited into a cohort study from gestation to 6 months after delivery. Maternal and child research data were collected via HCV antibody testing and HCV RNA testing.
Results: Maternal HCV RNA had statistically significant low diagnostic performance and characteristics in prediction of
developing neonatal positive HCV Ab (AUC = 0.749, SE = 0.050, Pvalue < 0.001, 95% CI = 0.651 – 0.847 , cutoff ≥ 4.7,
sensitivity = 0.839, specificity = 0.614) and positive HCV RNA (AUC = 0.787, SE = 0.080, P value = 0.007, 95% CI = 0.629 – 0.944, cutoff ≥ 9.2 sensitivity = 0.625, specificity = 0.870).
Conclusions: Possibly, there is inadequate or incomplete HCV screening of vulnerable neonates due to, low maternal healthcare compliance. Complete testing of all neonates at risk of vertically acquired HCV requires to be noted in medical
recording system as early management intervention could influence disease course.