There was an Aug. 24 Medscape gastroenterology article regarding
scoring babies with this condition.
Judy Ritchie

http://gastroenterology.medscape.com/reuters/prof/2001/08/08.21/20010820clin004.html

Simple Clinical Score Can Help in Diagnosis of
Neonatal Biliary Atresia


DELHI (Reuters Health) Aug 20 - 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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