A recent study (S Harpavat et al. JPGN 2018; 66: 850-6) identifies race/ethnicity as a factor affecting the timeliness of diagnosis.

Specifically, non-Hispanic white infants were diagnosed earlier than non-Hispanic black infants and Hispanic infants (P=.007); this was related to the timing of referral from the primary care physician.  The authors speculate that this could be related to three factors:

• lighter colored skin could help identify jaundice more quickly
• better access to health care
• implicit bias leading to uneven treatment

The other finding in the study was that after referral, patients referred after 30 days of life had a more expedited diagnosis than those referred prior to 30 days of life.  The authors caution that the histology in these early cases is similar to those who present later, even if their aminotransferases are normal.  In addition, while physicians and parents want to avoid ‘over testing,’ prompt diagnosis, even prior to 30 days of life, may lead to improved outcomes.  Thus, the authors recommend proceeding with liver biopsy if there is clinical suspicion of biliary atresia.

My take: Obtaining objective evidence of cholestasis in infants that are jaundiced beyond 2 weeks of life is important.  This study highlights some of the reasons why the diagnosis is delayed in so many.

Related blog posts:

• Will We Still Need Liver Biopsies to Diagnose Biliary Atresia in a Few Years?
• Newborn bilirubin measurements for biliary atresia
• Stool Color Cards -Not Flashy But Effective This post has a picture of a card and acholic (compared to normal) stools
• Neonatal cholestasis for neonatologists
• Guideline links for TEF and Infant Cholestasis
• Neonatal Cholestasis Lecture
• Diagnosing biliary atresia earlier | gutsandgrowth
• Helpful Review on Biliary Atresia | gutsandgrowth