title: Home-Based Screening for Biliary Atresia Using Infant Stool Color Cards in Canada: Quebec Feasibility Study.
abstract: OBJECTIVE
  Biliary atresia (BA) is a leading cause of liver failure and liver transplantation in pediatrics. BA manifests by 3 weeks of life with jaundice and pale stools. Delayed diagnosis and surgical intervention with Kasai portoenterostomy after 3 months of age is significantly associated with poor prognosis for native liver survival. A national Taiwan infant stool color card (SCC) screening program has entirely eliminated late Kasai portoenterostomy >90 days of age and improved native liver survival. A recent large-scale prospective cohort study in British Columbia, Canada, indicated that distribution of SCC on the maternity ward was feasible, led to high utilization rate, and was cost-effective. The aim of the present study was to assess the generalizability of this screening strategy in another Canadian jurisdiction with a different sociodemographic profile.
  
  
  METHODS
  An SCC was distributed to families of newborns discharged at St Mary's Hospital Center, Montreal, Quebec. Families were instructed to monitor their infant's stool color for 21 days and then complete and mail the SCC to the study center. Phone surveys to families who did not return cards were used to estimate total card utilization rate.
  
  
  RESULTS
  Two thousand two hundred forty-six infants were eligible for inclusion; 99.9% were enrolled. Mail SCC return rate was 63.3%. No cases of BA were identified. All of the 118 families who completed the phone survey reported that they had utilized the SCC. Conservative and optimistic estimates for total card utilization rates were 82% and 100%, respectively.
  
  
  CONCLUSIONS
  The high enrollment and utilization rates in this screening study strongly support the feasibility of implementing a Canadian SCC screening program to improve outcomes of children with BA.
authors.affiliation: *Department of Pediatrics †Research Center, St Mary's Hospital Center, McGill University ‡Department of Family and Emergency Medicine, Université de Montréal and CRCHUM, Montreal §Department of Pediatrics, University of British Columbia, Vancouver, Canada.
authors.forename: Véronique
authors.initials: V
authors.lastname: Morinville
authors.forename: Najma
authors.initials: N
authors.lastname: Ahmed
authors.forename: Cindy
authors.initials: C
authors.lastname: Ibberson
authors.forename: Lajos
authors.initials: L
authors.lastname: Kovacs
authors.forename: Janusz
authors.initials: J
authors.lastname: Kaczorowski
authors.forename: Stirling
authors.initials: S
authors.lastname: Bryan
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Collet
authors.forename: Richard
authors.initials: R
authors.lastname: Schreiber
mesh_terms: D001656:Biliary Atresia / Q000175:diagnosis*; D015331:Cohort Studies; D003116:Color; D005190:Family; D005240:Feasibility Studies; D005243:Feces / Q000737:chemistry*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006784:Hospitals, Teaching; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D015997:Neonatal Screening / Q000379:methods*; D010349:Patient Compliance; D010353:Patient Education as Topic; D011177:Postal Service; D011792:Quebec; D012648:Self Care; D057566:Self Report; D014504:Urban Health