This article is more than 5 years old. Information may no longer be current.

Stool card screening detects early biliary atresia among Japanese infants

Researchers in Japan found that a stool color card screening was effective in detecting biliary atresia in infants, according to study data published in The Journal of Pediatrics.

Researchers screened 313,230 live infants born following an issuance of stool color cards to all pregnant women in Tochigi Prefecture, Japan, between 1994 and 2011. The stool cards were given with the Maternal and Child Health Handbook to all pregnant women by their local government according to the Maternal and Child Health Law in Japan.

The mothers returned the completed stool color card to their pediatrician or obstetrician before or during the postnatal 1 month health checkup, after they were asked to fill out the correct number with the image of the stool color from the infant. The researchers sought to determine any hint of biliary atresia and its effect on long-term liver survival.

“For patients with positive stool color card results, the possibility of other types of infantile cholestasis was eliminated by a pediatric specialist or pediatric hepatologist through clinical, biochemical, radiologic, histologic and genetic investigations when necessary,” the researchers wrote. “A final diagnosis for high-risk cases was determined by laparotomy and/or operative cholangiography prior to Kasai procedure by a pediatric hepatologist or surgeon.”

All patients found to have biliary atresia underwent Kasai procedure as soon as possible, according to the research.

Overall, 313,230 infants were screened and 34 of these were diagnosed with biliary atresia. The incidence of biliary atresia among these infants was 1.1 in 10,000 infants (95% CI, 0.7-1.5). The infants with biliary atresia were followed from the date of their Kasai procedure until liver transplantation, death or October 2013. The mean age of the infants at the time of Kasai procedure was 59.7 days, according to the research.

The sensitivity of stool color card screening at the 1 month check-up was 76.5% (95% CI, 62.2-90.7) and its specificity was 99.9% (95% CI, 99.9-100). The positive predictive value at the 1 month check-up was 12.7% (95% CI, 8.2-17.3) and negative predictive value was 99.9% (95% CI, 99.9-99.9).

Seventeen infants underwent liver transplant, as of October 2013. Results from a Kaplan-Meier analysis showed that the liver survival probability at 5 years was 87.6%, 76.9% at 10 years and 48.5% at 15 years, when using an endpoint of transplantation, mortality or through October 2013. The median native liver survival was 197.2 months in patients who were referred quickly when positive stool color was reported and 212.5 months in patients with type 3 biliary atresia. The researchers indicated that the native liver survival probabilities at 5, 10 and 15 years “increased by more than 20%” during previous studies conducted in other Japanese cities where the stool color card was not used.    

“The stool color card was beneficial for patients with biliary atresia whose jaundice was not obvious,” the researchers concluded. “However, we are aware that the distribution of the stool color card in the community alone is not sufficient to achieve earlier detection of biliary atresia. Proper usage of the stool color card by guardians coupled with a sound knowledge of biliary atresia among healthcare personnel is essential.” – by Melinda Stevens

Disclosures: The researchers report no relevant financial disclosures.