Simple clinical score can help in diagnosis of neonatal biliary atresia

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DELHI (Reuters Health) – A new clinical scoring system, based on criteria that can be evaluated at the bedside, can help distinguish neonatal hepatitis from extrahepatic biliary atresia, according to a study conducted in India.

Dr. D. K. Gupta, from the All India Institute of Medical Sciences (AIIMS) in Delhi, and his team developed a scoring system using five clinical criteria assigned 2 points each: age; severity of jaundice; color of stools; color of urine; and feel of liver on palpation.

These criteria were applied retrospectively to 120 neonates with jaundice who had presented to AIIMS in the last 10 years. The AIIMS clinical score was compared with the results of hepatobiliary scans and pre-operative cholangiograms that had been ordered for all of the neonates.

In the July issue of the Indian Journal of Pediatrics, the researchers note that a score of less than 10–age of less than 6 weeks at onset of jaundice, severe jaundice, clay-colored stools, dark-colored urine and a firm liver with sharp edges–could predict biliary atresia with a sensitivity of 91.5%, a specificity of 76.3% and a diagnostic accuracy of 86.6%. In comparison, the hepatobiliary scan had a diagnostic accuracy of 68%.

A score of 10 or more was suggestive of neonatal hepatitis–a non-surgical condition, the researchers note. They recommend that neonates with a score less than 10 should be quickly worked up for surgery, and that the confirmatory test, cholangiography, should be performed promptly. In the event of no excretion of dye in the gut, a diagnosis of biliary atresia is certain and corrective surgery is needed, they add.

The AIIMS clinical score "could be used at any place, as it is a bedside scoring system and takes less than a minute [to perform]," Dr. Gupta pointed out in comments to Reuters Health.

Indian J Pediatr 2001;68:605-608.

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