Clinical and biochemical factors associated with biliary atresia

To determine the clinical and biochemical factors associated with biliary atresia.

This retrospective study was carried at the Pediatric Hepatobiliary Clinic, of a tertiary care referral center, from May 2005 to April 2006. Thirty-three infants with neonatal cholestasis were enrolled. All patients were evaluated by detailed history and clinical examination. Patients diagnosed with biliary atresia on intra-operative cholangiogram and liver biopsy underwent the Kasai operation. Clinical and biochemical factors predictive of biliary atresia were determined.

Seventeen infants (51.5%) had neonatal hepatitis, (42.4%) biliary atresia and two (6.1%) neonatal sepsis. Clay colored stools was the only clinical feature suggestive of biliary atresia which was seen in 11 biliary atresia children (79%) and was statistically significant (p = 0.05). No other biochemical markers were suggestive of biliary atresia, such as alkaline phosphatase (p = 0.10) or gamma glutamyl transferase (GGTP) (p = 0.64). On follow-up 6 patients (43%) with biliary atresia developed chronic liver disease and two patients (14%) died of their disease, whereas 41% patients with neonatal hepatitis made successful recovery. (p = 0.02)

Presence of clay colored stools is a predictive marker for biliary atresia and should be used as one of the markers for urgent cholangiogram, since most of the children with biliary atresia go on to develop chronic liver disease.