
Biliary atresia is a rare condition, but it can have serious consequences even in the first weeks of a child’s life. Atresia is an irreversible obstruction of the bile ducts, which leads to the destruction of the liver within a few weeks. "The only chance of preventing this lies in a very early diagnosis," explains Dr Omid Madadi-Sanjani from the Department of Paediatric Surgery at Hannover Medical School (MHH) . The senior physician and his now former colleague Professor Dr Claus Petersen have been working together with the Techniker Krankenkasse (TK) Lower Saxony for many years to strengthen the early detection of biliary atresia. Now they can be happy about a great success: A stool colour card, which can give indications of a possible bile duct obstruction, will become an integral part of the yellow booklet - and can thus be used for all newborns nationwide. This innovation was initiated in May of this year by a decision of the Federal Joint Committee (G-BA).
Early surgery is a chance for the liver
About one in 19,000 newborns is affected by biliary atresia. The obstruction of the bile ducts causes the bile to back up. If left untreated, this leads to fatal liver failure in the second or third year of life. The typical symptoms of the disease, which already appear in the first weeks of life, include persistent jaundice and pale stool colour. The disease can only be treated surgically. The time factor plays a decisive role in success. "If the child is operated on by a qualified team in the first two months of life, about 50 percent of these children can survive in the long term with their own liver," explains Professor Petersen. All the others receive a liver transplant sooner or later, which ensures survival but is associated with many lifelong restrictions.Supply gap is closed
Together with the TK, MHH has been actively promoting early diagnosis of biliary atresia since 2014. Since the end of 2016, all maternity clinics in Lower Saxony have been provided with stool cards for early detection, and in 2021 the stool card was digitalised and has since been available to all parents nationwide as the "Liver Check for Babies" app. With its inclusion in the Yellow Booklet, another big step has now been taken. "From our point of view, it is important to educate and act early, even in the case of rare diseases. Otherwise, there is a risk that these diseases will slip through the system. It is therefore all the more gratifying that the use of chair cards in the Yellow Booklet can now also close a gap in care nationwide," says Dirk Engelmann, head of the TK regional office in Lower Saxony.All parents receive the Yellow Booklet after the birth of a child from the maternity ward or the midwife. All examination results from U1 to U9 are recorded in the child examination booklet. According to estimates by the G-BA, the new Yellow Booklets, which have been expanded to include the stool colour card, can probably be distributed from autumn of this year.