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Population-based screening strategies for biliary atresia in the newborn: A systematic review and meta-analysis

Srirupa Hari Gopal1, Rema Zebda1, Arvind Mohan2

  • 1Division of Neonatal-Perinatal Medicine, Baylor College of Medicine & Texas Children's Hospital, Houston, Texas, United States of America.

Plos One
|August 28, 2024
PubMed

Insights

Newborn screening for biliary atresia (BA) using direct/conjugated bilirubin (DB/CB) shows high accuracy. Stool color card (SCC) screening is less sensitive but highly specific for early BA detection.

Area of Science:

  • Neonatal Medicine
  • Pediatric Gastroenterology
  • Diagnostic Accuracy Studies

Background:

  • Biliary atresia (BA) requires early diagnosis and intervention for improved infant outcomes.
  • Newborn screening strategies are being explored to facilitate timely BA detection.

Purpose of the Study:

  • To systematically review and assess the diagnostic accuracy of population-based newborn screening strategies for biliary atresia.
  • To compare the effectiveness of different screening tests, including stool color card (SCC) and direct/conjugated bilirubin (DB/CB).

Main Methods:

  • Systematic review adhering to PRISMA-DTA guidelines, including cohort and cross-sectional studies.
  • Meta-analysis of screening tests (SCC, DB/CB) against intraoperative cholangiogram as the reference standard.
  • Inclusion of 15 studies encompassing over 1.8 million participants.

Main Results:

  • Direct/conjugated bilirubin (DB/CB) assessed post-birth demonstrated high diagnostic accuracy: 100% sensitivity and 98.8% specificity.
  • Stool color card (SCC) screening at one month showed 79.6% sensitivity and 99.9% specificity.
  • Risk of bias assessment indicated potential concerns regarding patient selection and reference standard in some studies.

Conclusions:

  • Direct/conjugated bilirubin (DB/CB) in the initial days of life offers the most accurate diagnostic performance for population-based biliary atresia screening in newborns.
  • Future research should investigate the cost-effectiveness and potential benefits of combining screening strategies.
Abstract

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