{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T11:15:35Z","timestamp":1784891735413,"version":"3.55.0"},"reference-count":40,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2018,6,1]],"date-time":"2018-06-01T00:00:00Z","timestamp":1527811200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. pediatr. gastroenterol. nutr."],"published-print":{"date-parts":[[2018,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objectives:<\/jats:title><jats:p>Diagnosing biliary atresia (BA) quickly is critical, because earlier treatment correlates with delayed or reduced need for liver transplantation. However, diagnosing BA quickly is also difficult, with infants usually treated after 60 days of life. In this study, we aim to accelerate BA diagnosis and treatment, by better understanding factors influencing the diagnostic timeline.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods:<\/jats:title><jats:p>Infants born between 2007 and 2014 and diagnosed with BA at our institution were included (n = 65). Two periods were examined retrospectively: P<jats:sub>1<\/jats:sub>, the time from birth to specialist referral, and P<jats:sub>2<\/jats:sub>, the time from specialist referral to treatment. How sociodemographic factors associate with P<jats:sub>1<\/jats:sub> and P<jats:sub>2<\/jats:sub> were analyzed with Kaplan\u2010Meier curves and Cox proportional hazard models. In addition, to better characterize P<jats:sub>2<\/jats:sub>, laboratory results and early tissue histology were studied.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results:<\/jats:title><jats:p>P<jats:sub>1<\/jats:sub> associated with race\/ethnicity, with shorter times in non\u2010Hispanic white infants compared to non\u2010Hispanic black and Hispanic infants (<jats:italic>P<\/jats:italic> = 0.007 and <jats:italic>P<\/jats:italic> = 0.004, respectively). P<jats:sub>2<\/jats:sub> associated with referral age, with shorter times in infants referred after 30, 45, or 60 days of life (<jats:italic>P<\/jats:italic> &lt; 0.001, <jats:italic>P<\/jats:italic> &lt; 0.001, and <jats:italic>P<\/jats:italic> = 0.001, respectively). One potential reason for longer P<jats:sub>2<\/jats:sub> in infants referred \u2a7d30 days is that aminotransferase levels were normal or near\u2010normal. However, despite reassuring laboratory values, tissue histology in early cases showed key features of BA.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions:<\/jats:title><jats:p>Our findings suggest 2 opportunities to accelerate BA diagnosis and treatment. First, to achieve prompt referrals for all races\/ethnicities, universal screening strategies should be considered. Second, to ensure efficient evaluations independent of age, algorithms designed to detect early features of BA can be developed.<\/jats:p><\/jats:sec>","DOI":"10.1097\/mpg.0000000000001887","type":"journal-article","created":{"date-parts":[[2018,1,5]],"date-time":"2018-01-05T17:02:15Z","timestamp":1515171735000},"page":"850-856","source":"Crossref","is-referenced-by-count":30,"title":["Factors Influencing Time\u2010to\u2010diagnosis of Biliary Atresia"],"prefix":"10.1002","volume":"66","author":[{"given":"Sanjiv","family":"Harpavat","sequence":"first","affiliation":[{"name":"Department of Pediatrics Division of Gastroenterology, Hepatology, and Nutrition Baylor College of Medicine and Texas Children's Hospital Houston TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip J.","family":"Lupo","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Division of Hematology and Oncology Baylor College of Medicine and Texas Children's Hospital Houston TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Loriel","family":"Liwanag","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Division of Gastroenterology, Hepatology, and Nutrition Baylor College of Medicine and Texas Children's Hospital Houston TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Hollier","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Division of Gastroenterology, Hepatology, and Nutrition Baylor College of Medicine and Texas Children's Hospital Houston TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary L.","family":"Brandt","sequence":"additional","affiliation":[{"name":"Department of Surgery Baylor College of Medicine and Texas Children's Hospital Houston TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Milton J.","family":"Finegold","sequence":"additional","affiliation":[{"name":"Department of Pathology Baylor College of Medicine and Texas Children's Hospital Houston TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin L.","family":"Shneider","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Division of Gastroenterology, Hepatology, and Nutrition Baylor College of Medicine and Texas Children's Hospital Houston TX"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,6]]},"reference":[{"key":"e_1_2_6_2_2","doi-asserted-by":"publisher","DOI":"10.1002\/hep.21790"},{"key":"e_1_2_6_3_2","doi-asserted-by":"publisher","DOI":"10.1097\/MPG.0b013e318282a913"},{"key":"e_1_2_6_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2007.05.051"},{"key":"e_1_2_6_5_2","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2008-1949"},{"key":"e_1_2_6_6_2","doi-asserted-by":"publisher","DOI":"10.1097\/MPG.0b013e3181633562"},{"key":"e_1_2_6_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/0022-3468(90)90222-U"},{"key":"e_1_2_6_8_2","first-page":"473","article-title":"Biliary atresia: the Brazilian experience","volume":"86","author":"Carvalho ED","year":"2010","journal-title":"J Pediatr (Rio J)"},{"key":"e_1_2_6_9_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1440-1746.2007.05114.x"},{"key":"e_1_2_6_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2005.12.054"},{"key":"e_1_2_6_11_2","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0b013e3182300950"},{"key":"e_1_2_6_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.acap.2012.03.021"},{"key":"e_1_2_6_13_2","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2008-3108"},{"key":"e_1_2_6_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/0140-6736(93)91814-3"},{"key":"e_1_2_6_15_2","unstructured":"Clinical and Laboratory Standards Institute.EP28\u2010A3c: Defining Establishing and Verifying Reference Intervals in the Clinical Laboratory. 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