BILIARY ATRESIA, CYTOMEGALOVIRUS, AND AGE AT REFERRAL

Objective. To determine the frequency with which patients with extrahe patic biliary atresia (EHBA) are infected with cytomegalovirus (CMV) a nd to ascertain the age at referral to a specialty center for surgical correction of EHBA. Methods. The charts of all patients discharged fr om the Children's Hospital and Medical Center between July 1, 1989 and December 31, 1993 with a new diagnosis of EHBA were reviewed to deter mine the frequency with which EHBA was accompanied by CMV infection. D ata analyzed included age at referral and sex of patients, histopathol ogic evidence of CMV infection and size of bile ducts in the resected liver, and serologic (IgM) or culture diagnosis of CMV infection. Resu lts. Twenty-three patients with EHBA were evaluated at Children's Hosp ital and Medical Center in the study period. Twenty-one of the patient s with EHBA were appropriately evaluated for infection with CMV and in fection was documented in 5 (24%) patients. The median age of referral for all patients was 61 days (range 10 to 124 days). infected patient s were referred later (82.4 +/- 28.7 days) than noninfected patients ( 48.8 +/- 21.8 days) (P = .01) and were more likely to be girls, but th e medians of the diameters of the bile ducts in the resected porta hep atis were similar. Viral inclusions were not identified in any of the liver specimens. Conclusions. CMV infection is present in an unexpecte dly large proportion of patients with EHBA at the time of referral. Th e establishment of CMV infection in infants with cholestasis should no t deter the search for EHBA. Physicians should strive to reduce the ag e of referral of patients with EHBA to pediatric surgical centers by e valuating infants who remained jaundiced at 4 weeks of age.