Development of integrated neonatal cholestasis card for early recognition and referral of neonatal cholestasis
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ORIGINAL ARTICLE
Development of integrated neonatal cholestasis card for early recognition and referral of neonatal cholestasis Surender Kumar Yachha 1 & Mridul Chandra Das 1 & Praveen Kumar 2 & Lokesh Sharma 2 & Sumit Kumar Singh 1 & Moinak Sen Sarma 1 & Anup Kumar 3 & Anshu Srivastava 1 & Ujjal Poddar 1 Received: 2 June 2020 / Accepted: 8 September 2020 # Indian Society of Gastroenterology 2020
Abstract Introduction and Aim Delayed referral of neonatal cholestasis (NC) can result in significant morbidity and mortality. In this multi-center study, we aimed to evaluate the reliability of the stool card in the Indian population and develop an integrated NC card with (a) urine color identification and (b) stool color for early referral. Methods Consecutive children with NC were enrolled and divided into two groups (biliary atresia [BA] and non-BA). Normal healthy children at 6–8 weeks of age served as controls. Each photograph of stool and urine samples of every child was evaluated by 6 parents, 6 paramedical staff, and 4 trainee doctors using a stool color card as a reference for stool samples. Results Of 319 children (BA [n = 58], non-BA [n = 62], and controls [n = 199]), parents correctly detected dark yellow urine in all NC. Stool samples of 50 (86%) children with BA were unanimously labeled as pale by all observers. The average inter-item correlation showed good correlation between parents and trainee doctors of 0.77 and 0.64 with paramedical staff. Conclusion The integrated NC card proposes to recognize neonatal cholestasis at an early stage irrespective of etiology. It is a major step towards public health benefit both at the community as well as physicians’ levels to enable early detection and timely referral and management. Keywords Biliary atresia . Hepatobiliary . Infants . Liver . Neonatal cholestasis . Newborn . Stool card . Urine color
Introduction Neonatal cholestasis (NC) is defined as the presence of jaundice with dark yellow urine in a newborn, which requires early referral to the appropriate centers [1]. NC affects approximately 1 in every 2500 term infants in the West [2]. Observations from India have shown that NC constitutes 19% to 33% of hepatobiliary disorders in children [3]. Biliary atresia (BA) Supplementary Information The online version of this article (https:// doi.org/10.1007/s12664-020-01094-z) contains supplementary material, which is available to authorized users. * Surender Kumar Yachha [email protected] 1
Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226 014, India
2
Department of Pediatrics, Kalawati Saran Children’s Hospital, Lady Hardinge Medical College, New Delhi 110 001, India
3
Department and Biostatistics and Health Informatics, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226 014, India
constitutes the most common etiology of NC (30% to 34%) [1–4]. Intrahepatic causes constitute 45% to 69% of NC that includes potentially treatable metabolic disorders like galactosemia, tyrosinemi
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