It is recognized that there is often a delay in the diagnosis of biliary atresia (BA).  A recent study (MR Townsend et al. J Pediatr 2018; 199: 237-42) indicates that hepatoportoenterostomy (HPE) or Kasai procedure is performed in only 37.7% of patients with BA prior to 60 days of age. The data was obtained from the Agency for Healthcare Research and Quality’s Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample files from 2000-2011.

• Risk factors for delayed HPE: This study of 1243 patients with BA found that those with delayed HPE were more often uninsured–all self-pay patients had HPE after 60 days, more often black (aOR 4.22), and less likely at a teaching hospital (aOR 0.27).
• Delayed HPE was associated with increased adverse perioperative outcomes and increased cost.

My take: We have a long way to go if we are going to consistently identify and treat BA in a timely manner.

Related blog posts:

• Time-to-diagnosis of Biliary Atresia
• 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