Increased conjugated bilirubin is sufficient to initiate screening for biliary atresia.

INTRODUCTION: Biliary atresia is the leading cause of liver transplantation in children. It affects 1:15,000 in Denmark. With a national birth rate of 60,000, four children are born every year with biliary atresia. Early correction of biliary obstruction is essential to prevent fatal biliary cirrhosis. The Danish Health and Medicines Authority (DHMA) demands diagnostic evaluation of children with elevated level of serum bilirubin after two weeks of age. Biliary atresia has to be excluded if conjugated bilirubin level is above than 20 µmol/l, and/or more than 20% of total bilirubin. This percentage value has caused diagnostic trouble over the years. The objective of the present study was to investigate the possibility of changing the recommendations. METHODS: This was a retrospective analysis of the medical records of children operated for biliary atresia in the 1993-2012 period. RESULTS: During the period, 73 patients where operated with a portoenterostomy ad modum Kasai. Patients older than 84 days at the time of operation were excluded, 54 patients were available for analysis. Conjugated bilirubin in µmol/l and the percentage value were significantly above the DHMA threshold limit: mean 129.7 µmol/l (42-334 µmol/l) and 73% (28-97%), respectively. CONCLUSION: The total amount of conjugated bilirubin above 20 µmol/l is sufficient to require further evaluation for biliary atresia. The percentage value is unnecessary and may cause confusion. FUNDING: none. TRIAL REGISTRATION: not relevant.

[Late diagnostics and inadequate follow-up of asthma exacerbation].

Late diagnostics and inadequate follow-up of an asthma patient could have been avoided by use of accessible initiatives. Several differential diagnoses to dyspnoea and oppression of the chest exist and in this case a spirometry would have established the asthma diagnosis. Increasing specialization causes necessity to focus on differential diagnosis from nearby specialities. After hospitalization with asthma, the patient should be followed closely until asthma control is achieved and the necessary education is given so that inhalation technique and adherence is optimized.