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COVID-19 crisis causes drop in biliary atresia referrals

COVID-19 has had a significant impact on not only intensive care units but all other departments within health and social care.

Through our work with specialist paediatric liver centres, we have been made aware of the dramatic drop in referrals for investigations into biliary atresia since the coronavirus outbreak. Around 40 to 50 babies are diagnosed with biliary atresia each year within the UK. In all 3 specialist centres (Birmingham Children’s Hospital, King’s College Hospital, Leeds General Infirmary) there have been no cases found in the last four weeks and very little investigation activity.

This is very concerning. It is highly likely that there are babies out there who are poorly and early referral for these babies is vital. Extreme delay in referrals means that corrective surgery (Kasai), will not take place. This will lead to poor prognosis with the only resort being a liver transplant. Transplants are not only risky for very young children but also have a long-term impact on their health and lives. Furthermore, an increase in the need of transplants will lead to an even greater pressure on the NHS at this time.

Several newborn baby checks are carried out within the first few weeks of birth. We have been advised that the 14-day newborn health check via health visitors is continuing but the 6-week home visit for perinatal health may not be. It is not clear at this stage if the 6-week check by GPs have been reduced. Most cases of biliary atresia are picked up around the 4- 6 week stage.

We recognise that services across the country have been put under huge pressure with resources diverted to tackle the COVID-19 outbreak and staff members off work with infections and self-isolation. Visiting new parents where households are self-isolating have caused health professionals to carry out checks in alternative ways. However, these checks are essential in recognising signs of neonatal liver disease and for referrals to be made using the correct pathway.

We call upon all healthcare professionals involved in the care of newborn babies to check for signs of neonatal liver disease in babies with prolonged jaundice and follow up with parents regarding the need for testing if this is required, in whatever form the checks are taking place. Specialist paediatric liver centres and Children’s Liver Disease Foundation continue to be here to support you to ensure that checks, testing and referrals are maintained during this outbreak in order to reduce the long-term impact on the child of delayed diagnosis.

You can access CLDF Yellow Alert campaign resources to help you recognise the signs and symptoms of biliary atresia and other neonatal liver conditions including stool chart bookmarks, parent information booklet and jaundice protocol for professionals. You can download resources here or order on our online form.

If you have any queries , if we can help you to get the message out to other health care professionals or parents please do not hesitate to contact Harpreet Brrang (Information and Research Hub Manager) at or call 0121 212 6029.

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