Newborn screening for biliary atresia using direct bilirubin: An implementation science study.
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...
| Publicado en: | Journal of Medical Screening Vol. 32; no. 2; pp. 61 - 67 |
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| Autores principales: | , |
| Formato: | research tables/charts Journal Article |
| Publicado: |
Sage Publications Inc.
Jun2025
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=185414072&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 185414072 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 09691413 C0I jtl: Journal of Medical Screening issn: 09691413 maglogo: Y pubinfo: dt: Jun2025 vid: 32 iid: 2 pid: 344 pub: Sage Publications Inc. place: Thousand Oaks, California artinfo: ui: 185414072 179987603 185414072 185414072 10.1177/09691413241284243 185414072 ppf: 61 ppct: 6 formats: tig: atl: Newborn screening for biliary atresia using direct bilirubin: An implementation science study. aug: au: Rabbani, Tebyan Shah, Jay affil: 24349Lucile Salter Packard Children's Hospital at Stanford, Palo Alto, CA, USA sug: subj: Biliary Atresia Diagnosis Health Screening Methods Neonatal Assessment Bilirubin Blood Human Infant, Newborn Texas Academic Medical Centers Biliary Atresia Surgery Anastomosis, Surgical Methods Implementation Science Health Policy Gastroenterology Care Descriptive Statistics Infant, Newborn: birth-1 month ab: 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 (n = 1), retested <1.0 mg/dL (n = 40), and retested ≥1.0 mg/dL (n = 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. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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