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    Research Letter
    October 16, 2019

    Association of Early Direct Bilirubin Levels and Biliary Atresia Among Neonates

    Author Affiliations
    • 1Department of Pediatrics, Beaumont Children’s, Royal Oak, Michigan
    • 2Oakland University William Beaumont School of Medicine, Rochester, Michigan
    JAMA Netw Open. 2019;2(10):e1913321. doi:10.1001/jamanetworkopen.2019.13321

    Biliary atresia (BA) is a fibrosclerosing cholangiopathy resulting in obstruction of the biliary tree. Diagnosis and early performance of the Kasai hepatic portoenterostomy improves outcomes.1 Current guidelines recommend measurement of direct bilirubin (DB) or conjugated bilirubin levels in neonates who are still jaundiced at age 2 to 3 weeks.2,3 However, recent studies have documented the elevation of DB or conjugated bilirubin levels within the first days after birth in neonates with BA,4,5 suggesting that BA is a developmental cholangiopathy associated with a genetic, prenatal, or developmental event. To test this hypothesis, this case series evaluated DB levels in the first days after birth among neonates who were subsequently diagnosed with BA.