Use of near infrared reflectance spectroscopy in the screening for biliary atresia

doi:10.1016/0022-3468(94)90731-5

Journal of Pediatric Surgery

Volume 29, Issue 5, May 1994, Pages 645-647

https://doi.org/10.1016/0022-3468(94)90731-5 Get rights and content

Abstract

Early diagnosis is crucial for treatment and prognosis of biliary atresia (BA). We used near infrared reflectance spectroscopy (NIRS) for screening of BA. Fecal samples were collected from 200 healthy infants and 16 infants for whom either BA or neonatal hepatitis was diagnosed. Diagnoses were made retrospectively by other diagnostic methods, including laparotomy. The samples (0.5 g each) were manually homogenized. Reflected light from the surface of feces was measured by NIRS. Absorbance peak spectra for fecal fat and conjugated bilirubin were determined before the study, and proved to be 730, 1158, and 1210 nm, respectively. Two cutoff points were set in the second-derivative spectrum: the first (>−0.005) at 730 nm for conjugated bilirubin, and the second (<1.0) at 1,158:1,210 nm for fat (to include all patients with BA). The sensitivity of NIRS in the diagnosis of BA was 100%, and the specificity was 95.2%. The authors conclude that NIRS is a simple, rapid, noninvasive, and precise technique for the early diagnosis of BA.

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Cited by (19)

Interference between cerebral NIRS and conjugated bilirubin in extremely low birthweight neonates
2021, Anales de Pediatria
Near-infrared spectroscopy for medical applications: Current status and future perspectives
2016, Clinica Chimica Acta
Citation Excerpt :
The diagnostic potential of NIR spectroscopy was first demonstrated by Jöbsis who studied oxygenation in cats using this technique [3]. Since then NIR spectroscopy has been used to study a range of diverse conditions including epilepsy [4,5], metabolic myopathy [6], Friedreich's ataxia [7], skin carcinoma [8], type 2 diabetes mellitus [9], type 1 diabetes mellitus [10,11], MELAS (mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes) [12] and MERRF (myoclonic epilepsy with ragged red fibers syndrome) [12], valvular heart disease [13], atherosclerotic occlusive disease [14], Alzheimer's disease [15], aging [16], pigmented skin [17], breast cancer [18], biliary atresia [19], schizophrenia [20], pulmonary disease [21] and chronic fatigue syndrome (CFS) [22–26], virus infection [27], migraine [28], cervical dysplasia [29], atherosclerotic plaques [30], rheumatoid arthritis [31], hemodynamics [32], glioma [33], intraocular pressure [34], hemorrhagic shock [35], skin moisture [36], brain edema [37], optic neuritis [38] and maternal hypotension [39]. Most of these clinical analyses using NIR spectroscopy are based on monitoring two different wavelengths, which are chosen to exploit the differential absorption properties of oxygenated and deoxygenated hemoglobin.
The near-infrared radiation (NIR) window, also known as the “optical window” or “therapeutic window”, is the range of wavelengths that has the maximum depth of penetration in tissue. Indeed, because NIR is minimally absorbed by water and hemoglobin, spectra readings can be easily collected from the body surface. Recent reports have shown the potential of NIR spectroscopy in various medical applications, including functional analysis of the brain and other tissues, as well as an analytical tool for diagnosing diseases. The broad applicability of NIR spectroscopy facilitates the diagnosis and therapy of diseases as well as elucidating their pathophysiology. This review introduces recent advances and describes new studies in NIR to demonstrate potential clinical applications of NIR spectroscopy.
Neonatal cholestasis: Opportunities to increase early detection
2012, Academic Pediatrics
Citation Excerpt :
The use of a stool color chart has also been proposed for screening to identify the pale stool associated with cholestasis and has been used successfully in Asia and Argentina to improve time to diagnosis as well as surgical outcomes for BA.8,33,34 Other proposed screening strategies, including bile acid analysis with tandem mass spectroscopy and identification of sulfated bile acids in urine, are not readily available for routine testing and have not been validated in large populations.35–37 There are limitations to our survey.
To describe primary care management of early and prolonged jaundice in otherwise-healthy term infants to identify opportunities to increase early diagnosis of cholestasis.
Community-based pediatricians in St Louis, Missouri completed a mailed, anonymous, 29-item survey to assess practice demographics, timing of routine newborn office visits, and the management of early and prolonged neonatal jaundice.
A total of 108 of 230 (47%) of eligible physicians responded (mean years in practice, 15.3, SD, 9.4). More respondents were very familiar with national guidelines for management of early (49%) than prolonged (16%) neonatal jaundice. Eighty-six percent reported all newborns were checked with transcutaneous bilirubin before hospital discharge. For transcutaneous bilirubin results at 48 hours of 7, 10, 12 and 15 mg/dL, 1%, 26%, 70%, and 74% of respondents, respectively, would order a fractionated bilirubin. Although the first routine visit usually occurred in the first week after discharge, 25% of physicians reported the 2nd visit was routinely scheduled after 4 weeks of age. Ninety-four percent reported they would obtain a fractionated bilirubin for infants jaundiced beyond 4 weeks of age. If cholestasis was identified at 6 weeks of age, 32% would obtain additional testing without referral to a subspecialist.
Management of early and prolonged neonatal jaundice is variable. Current practices appear to miss opportunities for early diagnosis of cholestasis and referral that are unlikely to be addressed without redesigning systems of care.
The Jaundiced Infant: Biliary Atresia
2006, Pediatric Surgery: Sixth Edition
Biliary atresia
2000, Seminars in Pediatric Surgery
Population-based screening methods in biliary atresia: A systematic review and meta-analysis
2023, Archives of Disease in Childhood

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^☆: Presented at the 26th Annual Meeting of the Pacific Association of Pediatric Surgeons, Cairns, Queensland, Australia, May 9–14, 1993.

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Use of near infrared reflectance spectroscopy in the screening for biliary atresia☆

Abstract

J Pediatr Surg

Lancet

J Pediatr

Advances in the treatment of biliary atresia

Jpn J Surg

Improvement of results after Kasai operation: The need for early diagnosis and surgery

Jaundice at 14 days of age: Exclude biliary atresia

Arch Dis Child

Collaborative evaluation of universal calibrations for the measurement of protein and moisture in flour by near infrared reflectance

J Food Technol

Quantitation of cerebral blood volume in human infants by near-infrared spectroscopy

J Appl Physiol

Response of cerebral-blood volume to charges in arterial carbon dioxide tension in preterm and term infants

Pediatr Res