Reuters Health Information (2011-11-10): Stool color cards hasten referrals for biliary atresia
Drug & Device Development
Stool color cards hasten referrals for biliary atresia
Last Updated: 2011-11-10 18:23:12 -0400 (Reuters Health)
NEW YORK (Reuters Health) - Using stool color cards to screen newborns for biliary atresia increases both physician and parent awareness of the condition, and also leads to earlier treatment, Taiwanese researchers reported online in Pediatrics October 24th.
Lead author Dr. Jui-Ju Tseng of Taichung Veterans General Hospital and colleagues note that biliary atresia is the leading indication for liver transplant in infants.
The condition is more common in East Asia. In Taiwan, for example, the annual incidence is 1.46 per 10,000 neonates, according to the report. In the U.S., according to the American Liver Foundation, the incidence is 1 in 10,000.
The gold standard of treatment is the Kasai operation, or hepato-portoenterostomy. The earlier the Kasai operation is performed, the more likely it will cure jaundice and improve survival.
"Thus, the age of infants at the time of operation has traditionally been regarded as the key to their survival," Dr. Tseng and colleagues write. "Only early diagnosis of biliary atresia can lead to early operation."
In 2004, Taiwan launched a nationwide neonatal stool color card screening program. To determine whether the screening led to earlier diagnosis and treatment of biliary atresia, the researchers gathered data on all hospital patients with a diagnosis of biliary atresia between 1996 and 2008 from Taiwan's National Health Insurance Research Database.
Across the study period, the incidence of biliary atresia was 1.48 per 10,000 live births. Four hundred and forty children had a Kasai operation; another 32 received a liver transplant without a Kasai operation.
The median age at first admission to the hospital with a suspected biliary atresia diagnosis was 47 days before screening and 43 days afterward (P=0.028). The median age at operation dropped from 51 to 48 days (P=0.051).
Before the screening program was implemented, 68.9% of the Kasai operations were done before the patient was 60 days old and 9.5% were done in babies older than 90 days; afterward, 73.6% were done before 60 days and 4.9% were done after 90 days. Neither of those changes was statistically significant, however. The researchers say a significant result might be obtained from a larger sample size.
Stool card screening may be especially beneficial where the proportion of late referrals for biliary atresia is high, the researchers say. "Improvements in the speed of workup and speed to the operating room should be the focus of education and training in the future," they conclude.