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Reuters Health Information (2011-11-23): High bilirubin at birth may indicate risk of biliary atresia


High bilirubin at birth may indicate risk of biliary atresia

Last Updated: 2011-11-23 15:00:09 -0400 (Reuters Health)

NEW YORK (Reuters Health) - A retrospective study found that children with biliary atresia had elevated direct or conjugated bilirubin levels soon after they were born, researchers report in the December Pediatrics, available online now.

They say the findings suggest that screening and monitoring "could transform biliary atresia management by identifying affected infants early even before clinically significant liver injury develops."

Dr. Saul J. Karpen and colleagues at Baylor College of Medicine and Texas Children's Hospital in Houston note that biliary atresia is thought to be acquired when infants develop the bile duct obstruction some weeks after birth. Within months, this leads to end-stage liver disease, for which liver transplantation is the only option. However, if biliary atresia is diagnosed early, hepatic portoenterostomy (the so-called Kasai operation) may restore bile flow and delay cirrhosis.

But the researchers note that early diagnosis is difficult not only because the condition is rare (it occurs in about 1 in 10,000 infants) but also because the earliest clinical marker -- jaundice -- is often mistaken for more common forms of neonatal jaundice.

Aiming to determine the earliest point at which biliary atresia might be detected, the authors examined the records of 61 children with biliary atresia born at their center between 2007 and 2010. Direct bilirubin or conjugated bilirubin levels were measured within the first 96 hours of life in 34 of the children.

Every direct or conjugated bilirubin level measured during this neonatal period in these children exceeded the laboratory upper limit of normal, the team found.

However, total bilirubin levels were not very high, and were below phototherapy levels for healthy infants born at 37 weeks gestation. This may be why only 18 of the 34 infants had direct follow-up after discharge despite their elevated direct/conjugated bilirubin levels, the authors comment.

"Our findings suggest two possibilities that might improve current practice," Dr. Karpen and colleagues conclude. "(1) Screen all newborns for elevated DB/CB (direct/conjugated bilirubin) levels regardless of clinical appearance; and (2) Follow elevated DB/CB levels regardless of total bilirubin levels."

The authors of an editorial agree that if the findings are confirmed, biliary atresia could be easily detected using a common lab test. "Universally screening for BA by measuring direct and/or conjugated bilirubin levels in the first days of life may promote early referral and lead to a timely hepatoportoenterostomy procedure," say Drs. Ezequiel Neimark and Neal S. LeLeiko with Hasbro Children's Hospital and the Warren Alpert School of Medicine at Brown University, in Providence, Rhode Island.

However, they add, "New, larger, prospective studies must be performed. We hope that these studies will confirm the findings presented here and identify the best timing to ensure better outcomes."


Pediatrics 2011;128:e1428-e1433.

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