A PHP Error was encountered

Severity: Warning

Message: fopen(/var/lib/php/sessions/ci_sessionfcjp6jn04c09irhc29ion2pdbpap634u): Failed to open stream: No space left on device

Filename: drivers/Session_files_driver.php

Line Number: 177

Backtrace:

File: /var/www/html/index.php
Line: 316
Function: require_once

A PHP Error was encountered

Severity: Warning

Message: session_start(): Failed to read session data: user (path: /var/lib/php/sessions)

Filename: Session/Session.php

Line Number: 137

Backtrace:

File: /var/www/html/index.php
Line: 316
Function: require_once

Newborn screening for biliary atresia using direct bilirubin: An implementation science study. | LitMetric

Newborn screening for biliary atresia using direct bilirubin: An implementation science study.

J Med Screen

Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, UT Health San Antonio, San Antonio, TX, USA.

Published: September 2024

AI Article Synopsis

  • Biliary atresia (BA) is a serious liver condition in infants that requires early detection for better outcomes, with the ideal surgical intervention happening before 45 days of life, but the average age for surgery in this hospital was 60 days.
  • To improve early diagnosis, a new two-stage screening strategy was established that tested newborns for direct bilirubin levels shortly after birth and again at two weeks for those with elevated levels.
  • Over 16 months, 99.5% of infants were screened, identifying a small percentage with concerning bilirubin levels, leading to timely evaluations by gastroenterology and effectively ruling out BA by 28 days of life for most infants.

Article Abstract

Objective: Biliary atresia (BA) is a liver disease of infancy characterized by obstruction of the biliary tree. Infants with BA have the best outcomes when identified early and the Kasai portoenterostomy is performed before 45 days of life (DoL). In our hospital system, the average age at Kasai was 60 DoL. To address the problem of late presentation, we implemented a two-stage BA screening strategy utilizing direct bilirubin (DB).

Methods: New institutional policies were established that all newborns were tested at 24-48 h of life, and those with levels ≥0.5 mg/dL were followed further. The infant's primary care provider was contacted to recommend a repeat DB at 2 weeks of life. If the repeat DB was ≥1.0 mg/dL, the patient was evaluated by gastroenterology.

Results: Over the 16 months, 3880 infants were born and 3861 (99.5%) were screened; 53 infants (1.3%) had DB levels ≥0.5 mg/dL initially. Upon repeat testing at 2 weeks, there were three groups of infants: not retested ( = 1), retested <1.0 mg/dL ( = 40), and retested ≥1.0 mg/dL ( = 12). The average time to be seen by gastroenterology was 4.3 days or 18.3 DoL.

Discussion: The screening included a series of steps that needed to be implemented effectively. Screening had a net false positive rate of 0.3% (12 out of 3861) and identified causes of cholestasis other than BA. BA was excluded by 28 DoL on average. Our results can provide a template for other institutions interested in implementing a BA screening protocol in their practice.

Download full-text PDF

Source
http://dx.doi.org/10.1177/09691413241284243DOI Listing

Publication Analysis

Top Keywords

biliary atresia
8
direct bilirubin
8
levels ≥05
8
≥05 mg/dl
8
newborn screening
4
screening biliary
4
atresia direct
4
bilirubin implementation
4
implementation science
4
science study
4

Similar Publications

Background Kasai procedure (KPE) is a palliative intervention in infants with biliary atresia (BA) aiming to restore biliary drainage. While the measure of success in BA is the post-Kasai native liver survival, BA remains the most frequent indication for liver transplantation in children. While a considerable amount of children fail to clear their jaundice following KPE, resulting in early liver failure and transplantation, some children become jaundice-free after "successful" KPE.

View Article and Find Full Text PDF

Background & Aims: EGF-containing fibulin extracellular matrix protein 1 (EFEMP1, also called fibulin-3) is an extracellular matrix protein linked in a genome-wide association study to biliary atresia, a fibrotic disease of the neonatal extrahepatic bile duct. Fibulin-3 is deposited in most tissues and null mice have decreased elastic fibers in visceral fascia; however, fibulin-3 does not have a role in the development of large elastic fibers and its overall function in the extrahepatic bile ducts remains unclear.

Methods: We used staining and histology to define the amount and organization of key extracellular matrix components in the extrahepatic bile ducts.

View Article and Find Full Text PDF

Background: The pivotal importance of surgical treatment for pediatric biliary atresia is well-established. This systematic review and meta-analysis was designed to assess the comparative efficacy and safety of open portoenterostomy (OPE) and laparoscopic portoenterostomy (LPE) in managing this condition, providing valuable guidance for clinical decision-making.

Methods: A comprehensive literature review was conducted by two researchers in databases such as PubMed, up to July 10, 2024, focusing on studies that evaluated the role of LPE vs.

View Article and Find Full Text PDF

Objective: Choledochal malformation (CM) and biliary atresia (BA) are the two most important bile duct pathologies arising in infancy and childhood. The aim was to investigate for evidence of shared demographic features in a common temporo-spatial area.

Methods: Patients identified prospectively and defined as being born within metropolitan London in the period 1999-2022.

View Article and Find Full Text PDF

Want AI Summaries of new PubMed Abstracts delivered to your In-box?

Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!