A screening algorithm for the efficient exclusion of biliary atresia in infants with cholestatic jaundice

Journal of Pediatric Surgery
Tim JancelewiczJacob C Langer

Abstract

Neonates with cholestasis may undergo many tests before biliary atresia (BA) or an alternative diagnosis is reached, and delayed intervention may worsen outcomes. An optimal diagnostic approach to reduce risk, cost, and delay has yet to be defined. The purpose of this study was to develop an algorithm that rapidly and accurately excludes BA for infants with cholestatic jaundice. A single-center retrospective comparison of diagnostic workup was made between cholestatic infants with BA, and those without BA who underwent hepatobiliary iminodiacetic acid (HIDA) scan during admission. Patients were born between 2000 and 2010 and those older than 100days at assessment were excluded. Sensitivity and specificity analysis of predictive variables was performed and an algorithm constructed. There were 45 BA and 167 non-BA patients. Some variables were 100% sensitive for the exclusion of BA: conjugated bilirubin <2.5mg/dL, gamma-glutamyl transpeptidase <150U/L, excretion on HIDA, or a normal percutaneous cholangiogram. Clinical variables and ultrasound were less useful as screening tests owing to low specificity and sensitivity, respectively. Liver biopsy was 98% sensitive and 84% specific in the diagnosis of BA. An algorithm was construc...Continue Reading

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Citations

Jan 29, 2016·Gastroenterology Research and Practice·Murat AlkanUnal Zorludemir
Mar 21, 2016·Journal of Pediatric Surgery·Marie NguyenChristopher P Gayer
May 11, 2016·Journal of Hepatology·Henkjan J VerkadeClaus Petersen
May 28, 2016·Journal of Ultrasound in Medicine : Official Journal of the American Institute of Ultrasound in Medicine·Xiaoman WangQinglin Liu
May 12, 2017·PloS One·Benjamin L ShneiderUNKNOWN Childhood Liver Disease Research Network
Jan 10, 2018·Journal of Pediatric Gastroenterology and Nutrition·Sanjiv HarpavatBenjamin L Shneider
Feb 6, 2018·Pediatric Surgery International·Li WangJianghua Zhan
Jul 25, 2019·Journal of Pediatric Gastroenterology and Nutrition·Krupa R MysoreSanjiv Harpavat
Nov 24, 2017·Science Translational Medicine·Chatmanee LertudomphonwanitJorge A Bezerra
Nov 19, 2019·Journal of Pediatric Gastroenterology and Nutrition·Sahana ShankarWinita Hardikar
Aug 19, 2020·Journal of Paediatrics and Child Health·David X H LingUsha Krishnan
Jul 12, 2019·Journal of the Canadian Association of Gastroenterology·Zoya ChaudhryNajma Ahmed
Nov 12, 2018·Pediatric Surgery International·Sarah B CairoDavid H Rothstein
Sep 4, 2020·Clinical and Experimental Pediatrics·Pornthep TanpowpongSuporn Treepongkaruna
Mar 23, 2021·Seminars in Fetal & Neonatal Medicine·Naoki Tanimizu
Jul 17, 2021·Frontiers in Pediatrics·Andrea HoFaraz A Khan
Aug 8, 2021·Journal of Vascular and Interventional Radiology : JVIR·Grant A MorrisCarol J Potter
Nov 25, 2021·Current Gastroenterology Reports·Tebyan RabbaniSanjiv Harpavat

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