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Developmental assessment of infants with biliary atresia: differences between boys and girls
Susan E Caudle1, Jennifer M Katzenstein, Saul Karpen
1Section of Psychology, Psychology Service, Texas Children's Hospital, Baylor College of Medicine, Houston, TX 77030, USA. secaudle@texaschildrens.org
Insights
Infants with biliary atresia (BA) show developmental delays, particularly in language and motor skills. Female infants with BA may experience greater cognitive and skill deficits compared to males, potentially linked to higher C-bilirubin levels.
Area of Science:
- Pediatric Gastroenterology
- Neurodevelopmental Pediatrics
- Neonatal Research
Background:
- Biliary atresia (BA) is a serious neonatal liver disease.
- Infants with BA often exhibit developmental delays prior to liver transplantation.
- Sex-based differences in cognitive development among infants with BA are not well-established.
Purpose of the Study:
- To investigate cognitive differences between male and female infants with biliary atresia (BA).
- To confirm existing evidence of developmental lags in infants with BA before liver transplantation.
Main Methods:
- Utilized the Mullen Scales of Early Learning to assess 33 infants (21 female, 12 male) aged 3-20 months with BA.
- Compared cognitive scores between sexes and correlated them with clinical and biochemical markers.
Main Results:
- Both male and female infants with BA demonstrated developmental lags in expressive language and gross motor skills.
- Female infants showed significantly weaker visual reception skills (P=0.05) and a trend for expressive language deficits (P=0.08) compared to males.
- Higher C-bilirubin levels and shorter length were observed in female infants. Growth parameters correlated with expressive language, and international normalized ratio correlated with motor skills.
Conclusions:
- Infants with BA are susceptible to developmental delays before liver transplantation.
- Female infants with BA exhibit increased vulnerability to cognitive and skill delays compared to males.
- Elevated C-bilirubin levels may contribute to the heightened vulnerability observed in female infants.
Objective:
The aim of the present study was to investigate whether male and female infants with biliary atresia (BA) differ cognitively and to confirm previously documented developmental lags in infants with BA before liver transplantation.
Methods:
With the Mullen Scales of Early Learning, we examined 21 female and 12 male infants (ages 3-20 months) with BA, comparing scores across indices by sex and correlating Mullen Scales of Early Learning scores with standard clinical and biochemical parameters.
Results:
Overall, both boys and girls were found to be vulnerable to developmental lags in the areas of expressive language (EL) and gross motor skills. In comparison with their male peers, girls were found to be weaker in the area of visual reception skills (P=0.05) with a trend found for EL (P=0.08). Girls were also found to have higher C-bilirubin levels and to be of shorter length. Growth parameters were found to be correlated with EL scores. International normalized ratio was found to be correlated with gross motor performance and with a trend also noted for fine motor skills. Age at Kasai predicted receptive language skills.
Conclusions:
As has been shown, infants with BA appear to be vulnerable to developmental lags before transplantation. In particular, female infants appear to be vulnerable to cognitive and skill delays in comparison with their male peers. C-bilirubin levels may play a role in this increased vulnerability for females.
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