Repeatability and Reliability of Home-Based Stool Color Card Screening for Biliary Atresia Based on Results in China and Japan

Gu, Yan‐Hong; Kong, Yuanyuan; He, Yang; Diao, Mei; Li, Long; Tezuka, Michiko; Hanai, Junji; Matsui, Akira

doi:10.1620/tjem.252.365

Cited by 6 publications

(5 citation statements)

References 19 publications

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“…(Matsui [36], © 2013 reprinted by the permission of Springer Nature). A recent SCC screening program in Sapporo, Japan in 2012 and in the Chao Yang district in Beijing, China in 2013 reported that both centers used a seven-colour panel card while having three abnormal coloured stools [46]. In Beijing, the SCC was distributed directly at maternity, and the family was advised to bring the stools and their infant to the SCC screening centre if abnormal stool colour was detected.…”

Section: Ba Screening Using a Stool Color Cardmentioning

confidence: 99%

Biliary Atresia in 2021: Epidemiology, Screening and Public Policy

Schreiber

Harpavat

Hulscher

et al. 2022

JCM

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Biliary atresia (BA) is a rare newborn liver disease with significant morbidity and mortality, especially if not recognized and treated early in life. It is the most common cause of liver-related death in children and the leading indication for liver transplantation in the pediatric population. Timely intervention with a Kasai portoenterostomy (KPE) can significantly improve prognosis. Delayed disease recognition, late patient referral, and untimely surgery remains a worldwide problem. This article will focus on biliary atresia from a global public health perspective, including disease epidemiology, current national screening programs, and their impact on outcome, as well as new and novel BA screening initiatives. Policy challenges for the implementation of BA screening programs will also be discussed, highlighting examples from the North American, European, and Asian experience.

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Section: Ba Screening Using a Stool Color Cardmentioning

confidence: 99%

Biliary Atresia in 2021: Epidemiology, Screening and Public Policy

Schreiber

Harpavat

Hulscher

et al. 2022

JCM

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“…A systematic review and meta‐analysis of intervention trials concluded that the SCC reduces the age at KPE to around 60 days in countries with a pre‐intervention age of more than 70 days at surgery 13 . The SCC was included in the items systematically assessed during the ‘well baby visits’ of the first weeks of life, first in Taiwan in 2002, followed by Japan, China, Canada and recently in Switzerland, France and Germany 13,16‐23 . In Taiwan, the SCC improved the prognosis of infants with BA due to timely surgery 21 .…”

Section: Introductionmentioning

confidence: 99%

“…13 The SCC was included in the items systematically assessed during the 'well baby visits' of the first weeks of life, first in Taiwan in 2002, followed by Japan, China, Canada and recently in Switzerland, France and Germany. 13,[16][17][18][19][20][21][22][23] In Taiwan, the SCC improved the prognosis of infants with BA due to timely surgery. 21 Screening induced anxiety in parents was not demonstrated in a Swiss survey after SCC introduction.…”

mentioning

confidence: 99%

Awareness, referral and age at Kasai surgery for biliary atresia in Europe: A survey of the Quality‐of‐Care Task Force of ESPGHAN

Lacaille,

Nicastro,

Czubkowski

et al. 2024

J. pediatr. gastroenterol. nutr.

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ObjectivesTo identify infants with biliary atresia (BA), European Society of Paediatric Gastroenteroloy and Nutrition (ESPGHAN)/North American Society of Pediatric Gastroenteroloy and Nutrition (NASPGHAN) guidelines recommend measurement of conjugated/direct bilirubin in infants with prolonged jaundice and using a stool colour card (SCC). The ‘Quality of Care’ Task Force of ESPGHAN performed two surveys to assess current case finding for BA and age at Kasai portoenterostomy (KPE).MethodsThe first survey approached 26 European hepatology centres to report age at referral and age at KPE of all infants diagnosed with BA from 2015 to 2019. The second survey targeted paediatricians in France to assess awareness and compliance with the recently introduced SCC.ResultsData from 785 patients with BA from 18 centres in 15 countries revealed a mean age at referral to tertiary centre of 55 days (median 53, IQR 48–60) (n = 636). The mean age at KPE was 61 days (median 60; IQR 54–67) (n = 772). For 6% of patients, cirrhosis was too advanced for surgery.Of 392 paediatricians answering the second survey, 53% felt familiar with the target diseases, 80% correctly identified cholestasis and 59% always inquired about the infant's stool colour. If abnormal, 93% would order blood tests and 85% call for advice. The SCC screening was considered helpful for case finding and improving knowledge of cholestatic diseases by 62% and 45% paediatricians, respectively.ConclusionsReferral of infants for KPE remains late, indicating low adherence to search for cholestasis in icteric infants by age 2−3 weeks. Knowledge and structures need improvement to allow earlier guideline conform case finding, diagnosis and therapy.

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“…In Japan the SCC are distributed antenatal to parents with the Maternal and Child Health Handbook by the local government [ 3 ]. Since implementation of the screening, the age at diagnosis and Kasai procedure in this region decreased significantly, resulting in an improved survival with native liver and reduced transplant numbers [ 3 , 5 ]. Since then, numerous SCC screenings were implemented with differing protocols.…”

Section: Introductionmentioning

confidence: 99%

“…Since then, numerous SCC screenings were implemented with differing protocols. While governmental-led obligatory programs were implemented in Taiwan, Chinese provinces and Switzerland, voluntary programs with passive distribution strategies were established in Canada, Italy and Portugal [ 5 , 6 , 7 , 8 , 9 , 10 ]. However, all programs have in common, that they reported on earlier Kasai-procedures [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

Province-Wide Stool Color Card Screening for Biliary Atresia in Lower-Saxony: Experiences with Passive Distribution Strategies and Results

Madadi-Sanjani

Kuebler

Uecker

et al. 2021

IJNS

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Background: Stool color card (SCC) screenings for biliary atresia (BA) have shown to improve Kasai timing and outcome significantly. Both obligatory and non-obligatory screenings with passive distribution strategies have proven to be effective. Therefore, we have initiated a voluntary SCC program and aim to describe our experience. Methods: Since 2017 we supply all maternity wards in Lower-Saxony with SCC. Attending pediatricians and parents of BA infants were contacted via questionnaires and asked for their evaluation of the SCC screening. Results: 85.2% of attending pediatricians support the SCC screening, but only 78.1% considered the initiative useful. In their clinical routine, only 67% of visiting parents report to have received an SCC at the maternity hospital. In the group of parents of BA infants, only 54% (7/13) had received an SCC. Out of those seven parents, only one had referred their child to a children’s hospital based on pathological SCC results. The lack of SCC education in the maternity hospitals was made responsible by parents. Within three years, only one infant with BA was identified through the SCC. Conclusions: Our voluntary SCC screening shows serious limitations with inacceptable distribution of SCCs and low acceptance of attending pediatricians. SCC programs in decentralized health care systems without educational campaigns, standardized diagnostic and treatment algorithms and the definition of reference centers are additional burdens for local health care providers without the promised benefit.

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Repeatability and Reliability of Home-Based Stool Color Card Screening for Biliary Atresia Based on Results in China and Japan

Cited by 6 publications

References 19 publications

Biliary Atresia in 2021: Epidemiology, Screening and Public Policy

Biliary Atresia in 2021: Epidemiology, Screening and Public Policy

Awareness, referral and age at Kasai surgery for biliary atresia in Europe: A survey of the Quality‐of‐Care Task Force of ESPGHAN

Province-Wide Stool Color Card Screening for Biliary Atresia in Lower-Saxony: Experiences with Passive Distribution Strategies and Results

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