DIFFERENTIAL-DIAGNOSIS OF EXTRAHEPATIC BILIARY ATRESIA FROM NEONATAL HEPATITIS - A PROSPECTIVE-STUDY

The clinical presentations of cholestasis in infancy caused by neonata l hepatitis and biliary atresia are very similar. Diagnosis may be dif ficult on many occasions, but the surgical treatment of biliary atresi a should be performed as early as possible. We established a 3-day wor kup protocol for the differential diagnosis of biliary atresia and neo natal hepatitis and compared the diagnostic accuracy, sensitivity, spe cificity, and predictive values of various methods. One hundred and tw enty-six infants, including 84 with neonatal hepatitis (age, 65.1 +/- 24.1 days) and 42 with biliary atresia (age, 60.3 +/- 31.1 days), were studied prospectively from July 1982 to December 1990. The diagnostic accuracy of various methods was as follows: liver histology, 96.8%; c olor of duodenal juice, 91.6%; peak radioisotope count in duodenal jui ce, 84.2%; ultrasonographic examination of the hepatobiliary system, 8 0.2%; and persistence of clay-colored stool, 80.2%. After stepwise log istic regression, the diagnostic methods of significance were liver bi opsy, color of duodenal juice, abdominal ultrasonography, and stool co lor. However, stool color and the onset of jaundice could not differen tiate severe neonatal hepatitis from biliary atresia. The diagnostic m ethods of significance then were liver biopsy and duodenal juice color . With this 3-day protocol, no biliary atresia was missed although fou r cases of neonatal hepatitis were misdiagnosed, resulting in unnecess ary laparotomy; we found an overall diagnostic accuracy of 96.8%. We c onclude that this 3-day diagnostic protocol is very helpful in the dif ferential diagnosis of neonatal hepatitis and biliary atresia. Liver h istologic examination is the most reliable single test for the differe ntial diagnosis.