Development of a Bedside Scoring Tool to Screen for Biliary Atresia in Infants with Neonatal and Infantile Cholestasis in a Resource-limited Setting: an Observational Study.

OBJECTIVE

To develop an easy-to-use bedside scoring system to help physicians distinguish extrahepatic biliary atresia (EHBA) from other causes of neonatal and infantile (NIC) cholestasis.

METHODS

Medical records of all infants between 0 and 12 months of age diagnosed as NIC between January 2016 and December 2024 were reviewed. A diagnosis of EHBA was made based on histopathology findings, per-operative cholangiogram, and/ or intraoperative findings. Using logistic regression analysis, candidate variables that predicted biliary atresia were identified, and a scoring tool was developed.

RESULTS

A total of 119 cases of NIC were analyzed; 36 (30.2%) were diagnosed with EHBA. The mean (SD) age was 82.05 (43.7) days in the biliary atresia group and 92.7 (74.1) days in the non-biliary atresia (non-BA group). 16/36 patients with EHBA were below 60 days of age. Presence of pale stools, splenomegaly, elevated gamma-glutamyl transferase (> 5 times the upper limit of normal), and elevated alkaline phosphatase (> 2 times the upper limit of normal for age) were independent variables strongly associated with biliary atresia based on multivariate logistic regression analysis. The receiver operating characteristic curve (ROC) for the derived model had a sensitivity of 80.56%, specificity of 73.49% with an overall diagnostic accuracy of 78.99%.

CONCLUSION

This study provides a simple bedside scoring system that can be used to differentiate patients with EHBA from those with other causes of NIC. The derived score may enable clinicians to screen infants with NIC more effectively to optimize surgical outcomes in biliary atresia.