Three-step strategy composed of examination of infant eye color, stool color, and prior laboratory results
By Elana Gotkine HealthDay Reporter
TUESDAY, Feb. 18, 2025 (HealthDay News) — In a clinical report issued by the American Academy of Pediatrics and published online Feb. 18 in Pediatrics, recommendations are presented to assist primary care providers in identifying biliary atresia in newborns by 2 to 4 weeks of life.
Sanjiv Harpavat, M.D., Ph.D., from Baylor College of Medicine and Texas Children’s Hospital in Houston, and colleagues provide a strategy that can be used between 2 and 4 weeks of life at the “by 1 month” well-child visit in the Bright Futures/American Academy of Pediatrics “Recommendations for Preventive Pediatric Health Care.”
The strategy includes examination of infant eye color, stool color, and prior laboratory results to assess whether drawing a direct or conjugated bilirubin level is warranted. Step 1 assesses whether the eyes or skin appear jaundiced beyond 2 weeks of life; the strategy proceeds to Step 2 even if the answer is no. Step 2 examines whether stools are pale, gray, or white; the strategy proceeds to Step 3 even if the answer is no. Step 3 evaluates at whether bilirubin levels were previously checked and, if so, whether the initial value was above the laboratory’s range. The authors note the initial direct or conjugated bilirubin level will be high in biliary atresia, starting at birth. Skin and stool color should continue to be monitored even if the bilirubin levels were not checked or are not above the laboratory range, which could occur if compared with the wrong reference range.
“By identifying infants earlier, primary care providers have a unique opportunity to improve outcomes and help reduce the tremendous liver transplant burden of biliary atresia,” the authors write.
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