Diseases of bile duct in children

Table 1 Screening methods for biliary atresia

	Methods	Country (yr)	Sensitivity (%)	Specificity (%)	Prevalence of BA (per 10000 live births)	Outcomes/advantages
Yellow Alert campaign	Testing conjugated bilirubin in all babies with persistent jaundice after 2 wk	United Kingdom (1993)	N/A	N/A	N/A	N/A
SCC	Distribution of a picture of abnormal stool color to raise BA awareness	Japan[38] (1994)	76.5	99.9	1.1	The mean age of Kasai was 59.7 and 68.2 d, and NLS at 12.5 years was 48.5% vs 36.6% (SCC users vs non-users)
		Taiwan (2004)	84	99.9	1.7	67% of patients with BA underwent Kasai within 60 d
		China[57] (2013)	100	99.9	1.3	N/A
		British Columbia (2014)	83	99.9	0.7	The median age at Kasai was 49 vs 116 d (success vs failed program screening)
Mobile application	PoopMD[44]	United State (2015)	100	89	N/A	Easy to use; improve the ability to analyze near-normal stool color; automated reminder every 1-2 wk until 8 wk of life; current contact with a pediatrician if abnormal
	BabyPoop[45]	Japan (2017)	100	100	N/A
	Popòapp[46]	Italy (2020)	100	99	N/A
Fractionated bilirubin screening	Measuring conjugated bilirubin levels in all infants aged 4-28 d infants with conjugated bilirubin > 18 μmol or % conjugated bilirubin > 20% were followed up and further evaluated immediately	United Kingdom[49] (1995)	100	95.5	N/A	Can also identify other causes of cholestasis jaundice earlier
	N/A	United States[48] (1998)	100	99.9	1.7
Laboratory markers	Matrix metalloproteinase-7	United States[51] (2017)	97	91	N/A	N/A
		China[52] (2018)	98.6	95	N/A	52.85 ng/mL (AUC 0.99)
		Taiwan[58] (2019)	97	83	N/A	1.43 ng/mL (AUC 0.96)
		Iran[53] (2022)	95.5	94.5	N/A	7.8 ng/mL (AUC 0.98)

SCC: Stool color card; BA: Biliary atresia; NLS: Native liver survival; N/A: Not applicable; AUC: Area under the curve.