Using Stool Cards to Improve Biliary Atresia Screening in West Michigan Communities

Document Type

Conference Proceeding - Restricted Access

Publication Date

5-8-2026

Abstract

Biliary atresia (BA) is a disease that presents in the neonatal period involving an abnormal blockage, obstruction, or malformation of the bile ducts in the liver resulting in an inability to excrete bile from the body. Management is a corrective surgery called a Kasai procedure, where the standard of care is to do it before 60 days of life for the greatest chance of a successful outcome. Stool cards are a low-cost method to improve early detection of BA that have been used globally to help families identify acholic stools characteristic of BA and initiate workup sooner. As a screening tool, these cards have been found to statistically advance the diagnosis of BA in the communities where they have been introduced. Unfortunately it is unknown how they would affect the patient population cared for by HDVCH since no such stool card program has been implemented in West Michigan yet.

The project was designed as both a single-institution retrospective and prospective study investigating pediatric patients with BA receiving care at HDVCH before and after the introduction of our stool card. Infants with BA who were seen by the pediatric GI team at HDVCH over a time period from 2003 to 2025 were identified. We then collected data on the median age at which a referral to GI specialists was ordered, age at which the patients were seen by a GI provider, and the age at which a Kasai procedure was done. The percentage of patients who received a Kasai procedure before 60 days of life was also calculated. A stool card was designed by our team with the plan to distribute them to the newborn nursery service at HDVCH as well as pediatric primary care clinics in the greater Grand Rapids area. The plan moving forward is to collect data over the following years to assess statistically significant changes in the same metrics before and after the introduction of our stool cards.

In 27 infants seen at HDVCH for BA, the median age at referral to a GI specialist was 64 days of life (IQR 36-70) with an average of 59.8 ± 28.9 days. The median age at which they were seen by a GI provider was a difference of 1 day at 65 days of life (IQR 37-70) and an average of 60.6 ± 28.8 days. The median age at which a Kasai procedure was done was also 65 days of life (IQR 49.25-74.75). It was found that 10 out of 22 patients received a Kasai prior to 60 days of life for a rate of 45.45%. Compared to the available national data published in the literature, the metrics of BA patients at HDVCH show a delay in both diagnosis and treatment. Nationally, the median age of infants at Kasai is 57 days and the median age of an infant's first encounter with a gastroenterologist is 53 days. At Helen DeVos Children's hospital, it is 65 days for both of these metrics. The statistical significance of these differences cannot be determined at this time since some data was gathered from literature review.

Our results show a delay in care of 8 days and 12 days in the median age at which an infant with BA is referred to a GI specialist and receives a Kasai procedure, respectively. Since published literature has shown that such delays are statistically associated with increased morbidity and poorer outcomes, there is both an opportunity and an obligation for providers at HDVCH to improve the screening process for BA. It is our hope that our stool card project can be one such cost-effective initiative leading to earlier workup and treatment for BA in our patients.

Comments

2026 Research Day Corewell Health West, Grand Rapids, MI, May 8, 2026. Abstract 2087

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