Early Detection of Neonatal Cholestasis: Inadequate Assessment of Stool Color by Parents and Primary Healthcare Doctors

 

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Abstract

Introduction Early diagnosis and surgery (< 60 days of age) improve outcomes in children with biliary atresia. Only 56% of patients undergo timely surgery in the Netherlands. Lack of acquaintance with symptoms such as discolored stools might underlie this delay. We analyzed whether Dutch parents, youth healthcare doctors, or general practitioners recognized discolored stools and evaluated the effect of the Infant Stool Color Card (ISCC) on recognizing discolored stools.

Material and Methods We asked 100 parents, 33 youth healthcare doctors, and 50 general practitioners to classify photographs of stools as “normal” or “abnormal.” Subsequently, we asked whether parents would seek medical help and doctors would refer the patient for medical investigation. Finally, parents scored stools using the ISCC.

Results Two-third of both parents and youth healthcare doctors recognized all discolored stools. Only half of them would seek medical help for all discolored stools resp. refer patient for medical investigation. Only one-third of the general practitioners recognized all discolored stools and would refer for medical investigation for all discolored stools. Using the ISCC, the percentage of parents recognizing all discolored stool increased from 66 to 87% (p < 0.01).

Conclusion Neither parents nor youth healthcare doctors nor general practitioners reliably recognize discolored stool. The ISCC is an effective screening method for discolored stool. Our data indicate that the ISCC should be accompanied by unequivocal advices regarding referral for medical investigation upon detection of discolored stools.

• References

• 1 Hartley JL, Davenport M, Kelly DA. Biliary atresia. Lancet 2009; 374 (9702) 1704-1713
  CrossrefPubMedGoogle Scholar
• 2 Ohi R. Surgery for biliary atresia. Liver 2001; 21 (3) 175-182
  CrossrefPubMedGoogle Scholar
• 3 Hsiao CH, Chang MH, Chen HL , et al; Taiwan Infant Stool Color Card Study Group. Universal screening for biliary atresia using an infant stool color card in Taiwan. Hepatology 2008; 47 (4) 1233-1240
  PubMedGoogle Scholar
• 4 Lin YC, Chang MH, Liao SF , et al; Taiwan Infant Stool Color Card Study Group. Decreasing rate of biliary atresia in Taiwan: a survey, 2004-2009. Pediatrics 2011; 128 (3) e530-e536
  CrossrefPubMedGoogle Scholar
• 5 de Vries W, de Langen ZJ, Groen H , et al; Netherlands Study Group of Biliary Atresia and Registry (NeSBAR). Biliary atresia in the Netherlands: outcome of patients diagnosed between 1987 and 2008. J Pediatr 2012; 160 (4) 638-644.e2
  CrossrefPubMedGoogle Scholar
• 6 McKiernan PJ, Baker AJ, Kelly DA. The frequency and outcome of biliary atresia in the UK and Ireland. Lancet 2000; 355 (9197) 25-29
  CrossrefPubMedGoogle Scholar
• 7 Chardot C, Carton M, Spire-Bendelac N, Le Pommelet C, Golmard JL, Auvert B. Epidemiology of biliary atresia in France: a national study 1986-96. J Hepatol 1999; 31 (6) 1006-1013
  CrossrefPubMedGoogle Scholar
• 8 European Liver Transplant Registry. “Primary Indication of Liver Transplantation in Pediatric Patients”. Available at: http://www.eltr.org . Accessed 2013
  PubMedGoogle Scholar
• 9 Lien TH, Chang MH, Wu JF , et al; Taiwan Infant Stool Color Card Study Group. Effects of the infant stool color card screening program on 5-year outcome of biliary atresia in Taiwan. Hepatology 2011; 53 (1) 202-208
  CrossrefPubMedGoogle Scholar
• 10 Schreiber RA, Barker CC, Roberts EA et al. Biliary atresia: the Canadian experience. J Pediatr 2007; 151: 659-665 , 665.e1
  CrossrefPubMedGoogle Scholar
• 11 Serinet MO, Wildhaber BE, Broué P , et al. Impact of age at Kasai operation on its results in late childhood and adolescence: a rational basis for biliary atresia screening. Pediatrics 2009; 123 (5) 1280-1286
  CrossrefPubMedGoogle Scholar
• 12 Tseng JJ, Lai MS, Lin MC, Fu YC. Stool color card screening for biliary atresia. Pediatrics 2011; 128 (5) e1209-e1215
  CrossrefPubMedGoogle Scholar
• 13 Chang MH. Screening for biliary atresia. Chang Gung Med J 2006; 29 (3) 231-233
  PubMedGoogle Scholar
• 14 Schreiber RA, Masucci L, Kaczorowski J , et al. Home-based screening for biliary atresia using infant stool colour cards: a large-scale prospective cohort study and cost-effectiveness analysis. J Med Screen 2014; 21 (3) 126-132
  CrossrefPubMedGoogle Scholar
• 15 Lai MW, Chang MH, Hsu SC , et al. Differential diagnosis of extrahepatic biliary atresia from neonatal hepatitis: a prospective study. J Pediatr Gastroenterol Nutr 1994; 18 (2) 121-127
  CrossrefPubMedGoogle Scholar
• 16 Bakshi B, Sutcliffe A, Akindolie M , et al. How reliably can paediatric professionals identify pale stool from cholestatic newborns?. Arch Dis Child Fetal Neonatal Ed 2012; 97 (5) F385-F387
  CrossrefPubMedGoogle Scholar
• 17 Chen SM, Chang MH, Du JC , et al; Taiwan Infant Stool Color Card Study Group. Screening for biliary atresia by infant stool color card in Taiwan. Pediatrics 2006; 117 (4) 1147-1154
  CrossrefPubMedGoogle Scholar