Abstract

IntroductionBiliary atresia (BA) is the most common cause of cholestatic jaundice in infancy. Early diagnosis and surgical management, ideally before 60 days of age, result in improved outcomes. We aimed to determine the age at diagnosis of BA in the Military Health System (MHS) and to compare the age at diagnosis by access to care models. We hypothesized that children with BA receiving primary care in military facilities have an earlier age at diagnosis due to decreased economic and access barriers.MethodsData for all Tricare enrollees born in fiscal years 2004–2008 with a diagnosis of BA were extracted from MHS databases. Non-parametric tests, Kaplan-Meier curves and log rank tests compared differences in age at diagnosis by type of primary care facility, gender, prematurity and presence of additional anomalies.Results64 subjects were identified within the five year period. Median age at diagnosis was 40 days [range 1–189], with 67% diagnosed by 60 days and 80% by 90 days. 45 (70%) received civilian primary care within the MHS. There was no difference in the median age at diagnosis between subjects in the MHS with civilian primary care vs. military primary care (37 days [1–188] vs. 46 days [1–189]; p = 0.58).ConclusionIn the MHS, two-thirds of infants with biliary atresia are diagnosed prior to 60 days of life. Gender, prematurity or presence of additional anomalies do not affect the timing of diagnosis. Civilian and military primary care models within the MHS make timely diagnoses of biliary atresia at equivalent rates.

Highlights

  • Biliary atresia (BA) is the most common cause of cholestatic jaundice in infancy

  • Data for all Tricare enrollees born in fiscal years 2004–2008 with a diagnosis of biliary atresia (BA) were extracted from Military Health System (MHS) databases

  • Median age at diagnosis was 40 days [range 1–189], with 67% diagnosed by 60 days and 80% by 90 days. 45 (70%) received civilian primary care within the MHS

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Summary

Introduction

Biliary atresia (BA) is the most common cause of cholestatic jaundice in infancy. Diagnosis and surgical management, ideally before 60 days of age, result in improved outcomes. We hypothesized that children with BA receiving primary care in military facilities have an earlier age at diagnosis due to decreased economic and access barriers. The most common cause of cholestatic jaundice in the first months of life, and the major indication for pediatric liver transplantation, is biliary atresia (BA), a condition characterized by an inflammatory obliteration of the extrahepatic biliary system. Detection of BA permits surgical repair by the Kasai portoenterostomy, which can restore bile flow, prevent further biliary cirrhosis and worsening liver disease and prevent or at least delay liver transplantation [4]. It has been well established that the earlier the Kasai procedure is performed, the better the outcome, with the goal to perform this surgical procedure before 45 to 60 days of age [5,6,7]

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