Harpavat receives AASLD award for study on newborn screening tool to detect biliary atresia earlier

January 12, 2016

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Dr. Sanjiv Harpavat, a pediatric gastroenterologist at Texas Children’s and Baylor College of Medicine, received the 2015 Jan Albrecht Clinical and Translational Research Award in Liver Diseases from the American Association for the Study of Liver Diseases (AASLD) Foundation.

His study titled, “Assessment of a Novel Newborn Screening Tool for Biliary Atresia,” explores a new strategy to detect infants with biliary atresia earlier.

Biliary atresia is the most common indication for pediatric liver transplantation in the United States and worldwide. The only proven treatment for the disease is the Kasai portoenterostomy but this treatment has variable success in preventing or delaying need for transplantation.

One way to improve the success of the Kasai operation is to perform it earlier, with Kasai operations performed in the first 30 days of life correlating with the best outcomes. Unfortunately, infants with biliary atresia may appear normal in the first weeks of life and are difficult to detect. Because of this, in the United States, infants with biliary atresia are diagnosed and treated after 60 days of life on average.

Previously Harpavat and colleagues showed that all infants with biliary atresia have high direct or conjugated bilirubin measurements at birth. Using retrospective data, they predicted the test could be very sensitive and specific for biliary atresia.

Now Harpavat and colleagues hypothesize that universal newborn screening with direct or conjugated bilirubin measurements could be an effective way to identify biliary atresia earlier. They will prospectively screen all newborns from 10 hospitals in the Houston area and south Texas to determine the test’s sensitivity and specificity. They will also perform a cost-effective analysis using data obtained from the screen. Finally, they will assay easier ways to perform direct or conjugated bilirubin measurements, using a heel stick instead of venipuncture, for example.

Harpavat’s research study represents a broad collaboration among many divisions at Texas Children’s Hospital and Baylor College of Medicine, including investigators from Gastroenterology/Hepatology, Neonatology, Pediatric Surgery, Interventional Radiology, and Pathology. In addition, the group is working with public health experts at the University of Texas School of Public Health and clinicians at a large birth hospital in south Texas.

“Our goal is to improve outcomes in biliary atresia,” Harpavat said. “We are evaluating an affordable, widely-available, easily-interpretable test, that has the potential to hasten diagnostic times for infants with this serious disease.”