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Patients with biliary atresia have elevated direct/conjugated bilirubin levels shortly after birth

Sanjiv Harpavat1, Milton J Finegold, Saul J Karpen

  • 1Department of Pediatrics, BaylorCollege of Medicine, Houston,TX, USA.

Pediatrics
|November 23, 2011
PubMed

Insights

Biliary atresia (BA) infants show elevated direct/conjugated bilirubin (DB/CB) levels shortly after birth, even with normal total bilirubin. Early screening of DB/CB levels, not just ratios, can improve detection and outcomes for newborns with BA.

Area of Science:

  • Neonatal Medicine
  • Pediatric Gastroenterology
  • Bilirubin Metabolism

Background:

  • Biliary atresia (BA) is a serious neonatal liver disease.
  • Early diagnosis of BA is crucial for improved patient outcomes.
  • Current diagnostic approaches may miss early signs of BA.

Purpose of the Study:

  • To determine the earliest detectable time for biliary atresia (BA).
  • To investigate direct/conjugated bilirubin (DB/CB) levels in newborns with BA shortly after birth.
  • To hypothesize that newborns may not have acquired the disease immediately after birth.

Main Methods:

  • Retrospective analysis of newborn DB/CB levels from birth hospitals.
  • Inclusion of BA patients born between 2007-2010 and treated at Texas Children's Hospital.
  • Exclusion of patients with BA splenic malformation syndrome or prematurity; controls were healthy term newborns.

Main Results:

  • 56% of 61 BA subjects had measured newborn DB/CB levels, all exceeding norms.
  • BA infants had significantly higher mean DB levels at 24-48 hours (1.4 ± 0.43 mg/dL) vs. controls (0.19 ± 0.075 mg/dL).
  • Most BA patients (79%) had normal DB:TB ratios (≤0.2) despite elevated DB/CB.

Conclusions:

  • Elevated DB/CB levels are present shortly after birth in infants with BA.
  • Screening all newborns for elevated DB/CB levels, irrespective of jaundice appearance, is recommended.
  • Follow-up of all newborns with elevated DB/CB levels, not solely those with high DB:TB ratios, may enhance early BA detection.
Abstract

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