A recent report (Gu YH et al J Pediatr 2015; 166: 897-902) shows the cumulative experience of 19 years of using stool color cards to detect biliary atresia.  Cards were distributed to all pregnant women (Tochigi Prefecture, Japan) prior to or during the postnatal one-month health check.

Key findings:

• 34 patients detected among 313,230 live births. Reported sensitivity: 76.5% and specificity 99.9%.
• Mean age for performance of Kasai was 59.7 days.
• Improved long-term retention of native liver: 88% at 5 years, 77% at 10 years, and 49% at 15 years.

Limitation: Children in Western countries have had lower success rates following Kasai procedure, so it is unclear whether stool cards would be as effective in different regions.

Take-home message: Detecting biliary atresia earlier will improve outcomes.  Stool color cards should be an easy low-tech option.  Other options would include stool color apps and checking bloodwork.

Image below from Screenshot from John Pohl’s twitter feed:

Related blog posts:

• NASPGHAN awards | gutsandgrowth This link includes two awards related to biliary atresia. William Balistreri Award: “A Prospective Newborn Screening Study for Biliary Atresia” Sanjiv Harpavat and Young Clinical Investigator Award: “Poop-MD: A mobile health application accurately identifies acholic stools.” Douglas Mogul
• Outcome of “Successful” Biliary Atresia Patients | gutsandgrowth
• START Study: Steroids Not Effective For Biliary Atresia …
• Diagnosing biliary atresia earlier | gutsandgrowth