The American Academy of Pediatrics urges primary care providers to ask three questions to identify an infant with liver disease during the 2-4 week well-child visit, along with other recommendations in a clinical report published in the March 2025 Pediatrics. The report, “Identifying Infants With Biliary Atresia by 2–4 Weeks of Life: Guidance for the Primary Care Provider,” published online Feb. 18, observes that biliary atresia accounts for 60% of liver transplants in infants younger than 1 year and 30% of all liver transplants in pediatric patients. About 1 in 8000 to 18 000 newborns are affected by biliary atresia. Those who are treated before they reach 1 month old have a better chance at improved outcomes and are at lower risk of receiving a liver transplant. But biliary atresia can be difficult to identify because the infants often initially appear healthy. As a result, infants with biliary atresia typically are referred for surgery after the 2-month well-child visit, a delay that increases the likelihood of a liver transplant. In the report, the AAP recommends that primary care providers ask caregivers during the 2-4 week well-child visit: Is jaundice present? Are the stools pale? Was an initial direct or conjugated bilirubin level high? Multiple studies have reported that Hispanic and non-Hispanic Black infants with biliary atresia are referred later than non-Hispanic white infants. According to the AAP, this three-question universal screening strategy will help eliminate such health disparities. The clinical report was written by the AAP Section on Gastroenterology, Hepatology and Nutrition, the Committee on Fetus and Newborn, and the Section on Surgery. Clinical reports created by AAP are written by medical experts, reflect the latest evidence in the field, and go through several rounds of peer review before being approved by the AAP Board of Directors and published in Pediatrics.
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The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults.