Home-Based Screening for Biliary Atresia Using Infant Stool Color Cards in Canada: Quebec Feasibility Study
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Published on: September 20, 2016
Véronique Morinville1, Najma Ahmed, Cindy Ibberson
1*Department of Pediatrics †Research Center, St Mary's Hospital Center, McGill University ‡Department of Family and Emergency Medicine, Université de Montréal and CRCHUM, Montreal §Department of Pediatrics, University of British Columbia, Vancouver, Canada.
Insights
Implementing an infant stool color card (SCC) screening program in Montreal demonstrated high enrollment and utilization rates. This supports the feasibility of a national SCC screening program to improve early detection and outcomes for biliary atresia (BA).
Area of Science:
- Pediatric Gastroenterology
- Public Health Screening Programs
- Neonatal Care
Background:
- Biliary atresia (BA) is a primary cause of pediatric liver failure and transplantation.
- Timely diagnosis and surgical intervention (Kasai portoenterostomy) before 90 days of age are critical for native liver survival.
- Previous studies in Taiwan and British Columbia demonstrated the effectiveness and feasibility of infant stool color card (SCC) screening.
Purpose of the Study:
- To assess the generalizability of the SCC screening strategy in Montreal, Quebec, a Canadian jurisdiction with a different sociodemographic profile.
- To evaluate the feasibility, enrollment, and utilization rates of an SCC screening program in a new Canadian setting.
Main Methods:
- An infant stool color card (SCC) was distributed to families of newborns at St. Mary's Hospital Center, Montreal.
- Families were instructed to monitor infant stool color for 21 days and return the completed card.
- Phone surveys were conducted with non-returning families to estimate overall card utilization.
Main Results:
- 99.9% of 2,246 eligible infants were enrolled in the study.
- The mail return rate for SCCs was 63.3%, with estimated total utilization rates between 82% and 100%.
- No cases of biliary atresia were identified during the study period.
Conclusions:
- High enrollment and utilization rates indicate the feasibility of implementing a Canadian SCC screening program.
- Widespread SCC screening has the potential to improve early detection and outcomes for infants with biliary atresia.
- This strategy supports enhanced public health initiatives for neonatal liver disease surveillance.
Objectives:
Biliary atresia (BA) is a leading cause of liver failure and liver transplantation in pediatrics. BA manifests by 3 weeks of life with jaundice and pale stools. Delayed diagnosis and surgical intervention with Kasai portoenterostomy after 3 months of age is significantly associated with poor prognosis for native liver survival. A national Taiwan infant stool color card (SCC) screening program has entirely eliminated late Kasai portoenterostomy >90 days of age and improved native liver survival. A recent large-scale prospective cohort study in British Columbia, Canada, indicated that distribution of SCC on the maternity ward was feasible, led to high utilization rate, and was cost-effective. The aim of the present study was to assess the generalizability of this screening strategy in another Canadian jurisdiction with a different sociodemographic profile.
Methods:
An SCC was distributed to families of newborns discharged at St Mary's Hospital Center, Montreal, Quebec. Families were instructed to monitor their infant's stool color for 21 days and then complete and mail the SCC to the study center. Phone surveys to families who did not return cards were used to estimate total card utilization rate.
Results:
Two thousand two hundred forty-six infants were eligible for inclusion; 99.9% were enrolled. Mail SCC return rate was 63.3%. No cases of BA were identified. All of the 118 families who completed the phone survey reported that they had utilized the SCC. Conservative and optimistic estimates for total card utilization rates were 82% and 100%, respectively.
Conclusions:
The high enrollment and utilization rates in this screening study strongly support the feasibility of implementing a Canadian SCC screening program to improve outcomes of children with BA.
