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Screening for biliary atresia by infant stool color card in Taiwan
Shan-Ming Chen1, Mei-Hwei Chang, Jung-Chieh Du
1Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan.
Insights
A simple infant stool color card effectively screens for biliary atresia (BA), enabling early diagnosis and treatment to prevent liver damage. This method also aids in tracking BA incidence in Taiwan.
Area of Science:
- Pediatrics
- Hepatology
- Public Health Screening
Background:
- Biliary atresia (BA) can cause severe liver damage if diagnosis and treatment are delayed.
- Early detection is crucial for improving outcomes in infants with BA.
Purpose of the Study:
- To implement an early infant screening program for biliary atresia (BA) in Taiwan.
- To investigate the incidence of BA in the screened population.
Main Methods:
- A pilot study utilized an "infant stool color card" for parents to assess stool color.
- Stool color was checked by medical staff at 1-month checkups, with data sent to a registry center.
- The study involved 78,184 infants over a 22-month period.
Main Results:
- The stool color card screening achieved a sensitivity of 89.7% and specificity of 99.9%.
- 26 out of 29 diagnosed BA infants were identified before 60 days of age.
- The estimated incidence of BA was 3.7 per 10,000 live births.
Conclusions:
- The infant stool color card is a simple, efficient, and applicable mass screening tool for early BA diagnosis.
- This screening program facilitates early management and aids in BA incidence estimation and patient registry.
- Early detection through stool color screening significantly improves the chances of timely surgical intervention.
Objective:
We aimed to detect biliary atresia (BA) in early infancy to prevent additional liver damage because of the delay of referral and surgical treatment and to investigate the incidence rate of BA in Taiwan.
Methods:
A pilot study to screen the stool color in infants for the early diagnosis of BA was undertaken from March 2002 to December 2003. We had designed an "infant stool color card" with 7 numbers of different color pictures and attached it to the child health booklet. Parents were then asked to observe their infant's stool color by using this card. The medical staff would check the number that the parents chose according to their infant's stool color at 1 month of age during the health checkup and then send the card back to the stool color card registry center.
Results:
The average return rate was approximately 65.2% (78,184 infants). A total of 29 infants were diagnosed as having BA, and 26 were screened out by stool color card before 60 days of age. The sensitivity, specificity, and positive predictive value were 89.7%, 99.9%, and 28.6%, respectively. Seventeen (58.6%) infants with BA received a Kasai operation within 60-day age period. The estimated incidence of BA in screened newborns was 3.7 of 10,000.
Conclusions:
The stool color card was a simple, efficient, and applicable mass screening method for early diagnosis and management of BA. The program can also help in estimating the incidence and creating a registry of these patients.
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