NEW YORK (Reuters Health) – A retrospective study found that children diagnosed with biliary atresia had elevated direct or conjugated bilirubin levels soon after they were born, researchers report in the December issue of Pediatrics.

They say the findings suggest a screening and monitoring strategy that “could transform BA (biliary atresia) management by identifying affected infants early even before clinically significant liver injury develops.”

Dr. Saul J. Karpen and colleagues at Baylor College of Medicine and Texas Children’s Hospital, Houston, note that biliary atresia is thought to be acquired when infants develop the bile duct obstruction some weeks after birth. This leads to end-stage liver disease in the following months, for which liver transplantation is the only option. However, if biliary atresia is diagnosed within the first months, hepatic portoenterostomy may restore bile flow and delay cirrhosis.

However, they continue, early diagnosis is difficult not only because the condition is rare (it occurs about 1 in 10,000 infants) but also because the earliest clinical marker – jaundice – is often mistaken for more common forms of neonatal jaundice.

Aiming to determine the earliest point at which biliary atresia might be detected, the authors examined the records of 61 children with biliary atresia who were born at their center between 2007 and 2010. Direct bilirubin or conjugated bilirubin levels were measured within the first 96 hours of life in 34 of the children.

Every direct or conjugated bilirubin level measured during this neonatal period in these children exceeded the laboratory upper limit of normal, the team found.

However, total bilirubin levels were not very high, and were below phototherapy levels for healthy infants born at 37 weeks gestation. This may be why only 18 of the 34 infants had direct follow-up after discharge despite their elevated direct/conjugated bilirubin levels, the authors comment.

“Our findings suggest 2 possibilities that might improve current practice,” Dr. Karpen and colleagues conclude. “1) screen all newborns for elevated DB/CB (direct/conjugated bilirubin) levels regardless of clinical appearance; and (2) follow elevated DB/CB levels regardless of TB (total bilirubin) levels.”

The authors of a related editorial agree that if the findings are confirmed, biliary atresia could be easily detected in newborns by using a common lab test. “Universally screening for BA by measuring direct and/or conjugated bilirubin levels in the first days of life may promote early referral and lead to a timely hepatoportoenterostomy procedure,” say Drs. Ezequiel Neimark and Neal S. LeLeiko with Hasbro Children’s Hospital and the Warren Alpert School of Medicine at Brown University, in Providence, Rhode Island.

However, they add, “New, larger, prospective studies must be performed. We hope that these studies will confirm the findings presented here and identify the best timing to ensure better outcomes.”