Abstract
The infant stool color card screening system (CCSS) is used to confirm stool color in order to increase the rate of early diagnosis of biliary atresia (BA). In 2012, a nationwide stool CCSS was introduced in Japan. Here, we report the cases of three infants with BA, who could not be diagnosed using the stool CCSS. The infants underwent surgery at approximately 3 months of age. Each infant initially had yellowish stools that became pale yellow or whitish. Mothers and caregivers should be made aware that infants with BA usually pass yellowish stools in the early neonatal period, which may become pale yellow or whitish later. Mothers, physicians, and public health nurses tend to be unaware of BA owing to normalcy bias, which is a major problem. The following measures are important in order to diagnose BA using a stool color card and improve the prognosis of infants with BA: (1) mothers should check the stool color of infants regularly; (2) information should be unified and consistently provided to pediatric surgeons, pediatricians, and public health nurses; and (3) the healthcare system should be reformed and made more convenient to avoid overlooking BA. Measuring bilirubin and urinary sulfated bile acid levels and obtaining images of stools are useful and cost-effective methods to screen for BA.
