Evaluation of the diagnostic process in neonates with conjugated hyperbilirubinaemia.

INTRODUCTION

The Danish Health Authority (DHA) recommends diagnostic evaluation of infants who develop prolonged jaundice and a serum conjugated bilirubin (CB) concentration ≥ 17 μmol/l. This study aimed to assess the efficacy of the programme in identifying infants with biliary atresia (BA) or other liver disease. Infants born in the Central Denmark Region from 2016 to 2021 were investigated.

METHODS

A total of 693 infants were identified in the Central Biochemical Database (Labka). From a review of all medical records, CB measurements, results from diagnostic procedures and the final diagnosis were documented.

RESULTS

Four infants were identified with BA. They had a mean CB concentration of 105 μmol/l. A total of 33 infants were diagnosed with other cholestatic diseases; this group had a mean CB concentration of 58.9 μmol/l. The remaining 656 infants with a mean CB of 20.5 μmol/l recovered spontaneously without any sign of cholestatic disease. Approximately 75% of all HIDA scintigraphies (100/134) were conducted in 647 infants with a maximum CB concentration less-than 30 μmol/l. They all had bile drainage to the intestines. Among these infants, twelve were diagnosed as heterozygote for alfa-1-antitrypsin deficiency.

CONCLUSION

The CB threshold limit recommended by the DHA detected all patients with BA, but its use leads to over-investigation and over-diagnosing.

FUNDING: not relevant.

TRIAL REGISTRATION: not relevant.