Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2011 Dec;128(6):e1428-33.
doi: 10.1542/peds.2011-1869. Epub 2011 Nov 21.

Patients with biliary atresia have elevated direct/conjugated bilirubin levels shortly after birth

Sanjiv Harpavat  1 , Milton J Finegold, Saul J Karpen
Affiliations

Patients with biliary atresia have elevated direct/conjugated bilirubin levels shortly after birth

Sanjiv Harpavat et al. Pediatrics. 2011 Dec.

Abstract

Objectives: Healthy infants are thought to acquire biliary atresia (BA) in the first weeks of life. Because those diagnosed earlier have better outcomes, we were interested in determining the earliest time BA could be detected. We started by examining the immediate postnatal period, hypothesizing that newborns would not yet have acquired disease and still have normal direct/conjugated bilirubin (DB/CB) levels.

Patients and methods: Newborn DB/CB levels were obtained retrospectively from birth hospitals. Subjects with BA were born between 2007 and 2010 and cared for at Texas Children's Hospital. Those with BA splenic malformation syndrome or born prematurely were excluded. Control subjects were term newborns who later never developed neonatal liver disease.

Results: Of the 61 subjects with BA, 56% had newborn DB/CB levels measured. All DB/CB levels exceeded laboratory norms and rose over time. At 24 to 48 hours of life, subjects with BA had mean DB levels significantly higher than those of controls (1.4 ± 0.43 vs. 0.19 ± 0.075 mg/dL, P < .0001), even while their mean total bilirubin (TB) levels remained below phototherapy limits. Finally, despite the elevated DB/CB levels, the majority of patients (79%) had normal DB:TB ratios ≤ 0.2.

Conclusions: Patients with BA have elevated DB/CB levels shortly after birth. To detect affected infants earlier and improve outcomes, the results suggest two possibilities: (1) screen all newborns for elevated DB/CB levels, rather than just those who appear jaundiced; and then (2) follow all newborns with elevated DB/CB levels, rather than just those with DB:TB ratios >0.2.

PubMed Disclaimer

Figures

FIGURE 1
FIGURE 1
Patient selection. The 27 subjects with DB levels measured had 71 total measurements between 0 and 96 HoL, whereas the 7 subjects with CB levels measured had 13 total measurements. BASM indicates BA splenic malformation.
FIGURE 2
FIGURE 2
Patients with BA have elevated DB and CB levels immediately after birth. A, Mean DB levels at 0 to 24 HoL (n = 6), 24 to 48 HoL (n = 24), 48 to 72 HoL (n = 11), and 72 to 96 HoL (n = 12). Each subject's earliest measurement per interval was used. B, CB levels. The dashed lines indicate the upper limits of normal: 0.5 mg/dL (A) and 0.3 mg/dL (B).
FIGURE 3
FIGURE 3
Patients with BA have elevated DB, but not TB, levels at 24 to 48 HoL. Shown are the mean DB (A) and TB (B) levels for controls (n = 300; collection time: 39 ± 5.6 HoL) versus patients with BA (n = 24; collection time: 34 ± 6.2 HoL). The dashed lines indicate the upper limits of normal (A, 0.5 mg/dL), or the approximate phototherapy level at 34 HoL (B, 11.2 mg/dL). a P < .0001.
FIGURE 4
FIGURE 4
The majority of patients with BA have a DB/TB ratio of ≤0.2. Shown are the mean DB/TB ratios for controls (n = 242) versus patients with BA (n = 24). Only subjects with a TB level of >5 mg/dL were used for analysis. The dashed line indicates the recommended normal limit (0.2). a P < .0001.
See this image and copyright information in PMC

Comment in

  • Commentary.
    Haafiz AB. Haafiz AB. Clin Chem. 2015 Feb;61(2):333-4. doi: 10.1373/clinchem.2014.229831. Clin Chem. 2015. PMID: 25632098 No abstract available.

References

    1. Sokol RJ, Shepherd RW, Superina R, Bezerra JA, Robuck P, Hoofnagle JH. Screening and outcomes in biliary atresia: summary of a National Institutes of Health workshop. Hepatology. 2007;46(2):566–581 - PMC - PubMed
    1. Mieli-Vergani G, Vergani D. Biliary atresia. Semin Immunopathol. 2009;31(3):371–381 - PubMed
    1. Hartley JL, Davenport M, Kelly DA. Biliary atresia. Lancet. 2009;374(9702):1704–1713 - PubMed
    1. 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 - PubMed
    1. Davenport M, Tizzard SA, Underhill J, Mieli-Vergani G, Portmann B, Hadzic N. The biliary atresia splenic malformation syndrome: a 28-year single-center retrospective study. J Pediatr. 2006;149(3):393–400 - PubMed

Publication types