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Pre-operative time course changes in liver function tests in biliary atresia: its usefulness in the discrimination of
I Yamagiwa1, M Iwafuchi, K Obata
1Second Department of Surgery, Yamagata University School of Medicine, Japan.
Insights
Early detection of biliary atresia in infants is possible using liver function tests. Direct bilirubin levels within the first week and gamma-glutamyl transpeptidase levels by six weeks can help distinguish biliary atresia from other conditions.
Area of Science:
- Pediatric Gastroenterology
- Neonatalaundice
- Hepatobiliary Diseases
Background:
- Extrahepatic biliary atresia (BA) is a serious neonatal condition requiring early diagnosis.
- Differentiating BA from other cholestatic diseases like neonatal hepatitis (NH) can be challenging.
Purpose of the Study:
- To investigate the utility of routine liver function tests (LFTs) for early discrimination of BA in infants.
- To establish specific LFT parameters and timelines for distinguishing BA from physiological jaundice and NH.
Main Methods:
- Retrospective review of LFT results in infants within 12 weeks of birth.
- Comparison of LFTs in 47 infants with BA, 10 with NH, and 130 age-matched controls (CO).
- Analysis of mean test values per week post-birth, focusing on bilirubin and gamma-glutamyl transpeptidase.
Main Results:
- Aminotransferase levels showed no difference between BA and CO within 2 weeks.
- Total and direct bilirubin levels were significantly higher in BA infants within 1 week compared to controls.
- Direct bilirubin exceeded 2 mg/dL within the first week in all BA infants.
- The direct-total bilirubin ratio surpassed 25% within the first week in BA.
- Gamma-glutamyl transpeptidase levels were significantly elevated in BA compared to CO from 4 weeks and distinct from NH from 6 weeks.
Conclusions:
- Direct bilirubin measurement within the first week of life is a valuable tool for identifying BA from physiological jaundice.
- Gamma-glutamyl transpeptidase levels can help differentiate BA from NH by 6 weeks of age.
- Routine LFTs provide critical early indicators for diagnosing neonatal cholestatic conditions.
Abstract:
In order to investigate the possibility of early discrimination of extrahepatic biliary atresia from other cholestatic diseases, a series of results of liver function tests in infants with cholestatic diseases were reviewed. The results of routine liver function tests (LFT) recorded in patients' charts were reviewed within 12 weeks after birth in 47 infants with extrahepatic biliary atresia (BA), 10 infants with neonatal hepatitis (NH) and 130 age-matched control infants (CO) without cholestatic diseases. The mean of each test value for each week after birth was derived from the actual data examined in each infant. No differences were observed between BA and CO in the levels of aminotransferases within 2 weeks after birth. Total bilirubin and direct bilirubin levels were significantly different between BA and CO within 1 week after birth (16.1 +/- 3.2 mg/dL vs 11.1 +/- 4.5 mg/dL, 4.6 +/- 2.6 mg/dL vs 0.7 +/- 0.3 mg/dL, respectively). The direct bilirubin-total bilirubin ratio exceeded 25% within the first week in BA. The individual values of direct bilirubin (DB) exceeded 2 mg/dL within the first week in all infants with BA, while none of the individual values exceeded 1.6 mg/dL in CO. Gamma-glutamyl transpeptidase levels were significantly different between BA and CO at 4 weeks (432 +/- 272 IU/L vs 79 +/- 43 IU/L) and thereafter; and were significantly different between BA and NH at 6 weeks (314 +/- 232 IU/I vs 69 +/- 58 IU/L) and thereafter. These data suggest that the determination of direct bilirubin within 1 week after birth can detect extrahepatic biliary atresia patients from those with physiologic jaundice, and gamma-glutamyl transpeptidase levels may discriminate BA from NH at no later than 6 weeks of age.