Early Detection of Biliary Atresia in Primary Health Care

Atresia Bilier (AB) adalah penyebab paling umum penyakit hati stadium akhir pediatrik dan merupakan penyebab utama transplantasi hati pada anak-anak, saat ini tetap menjadi tantangan bagi dokter. Atresia bilier ditemukan di seluruh dunia, dengan angka kejadian 1 dari 10-19.000 di Eropa dan Amerika Utara, dan angka kejadian yang lebih tinggi yaitu 1 dari setiap 3.000 bayi di Asia Timur. Secara klinis, pada bayi dengan atresia bilier, ikterus kolestatik berkembang dalam beberapa minggu pertama kehidupan diikuti dengan tinja acholic, urin berwarna gelap, hepatomegali, pertumbuhan yang buruk, berkembang menjadi sirosis, hipertensi portal, dan gagal hati. Gejala Atresia bilier terus memburuk dua minggu setelah lahir. Berbeda dengan penyakit kuning fisiologis. Ikterus fisiologis akan membaik dalam waktu 2 minggu dan semakin membaik. Sedangkan pada kolestasis yang terjadi akibat atresia bilier, ikterus akan semakin parah. Sayangnya, identifikasi bayi dengan ikterus kolestatik cukup sulit karena tampak mirip dengan ikterus fisiologis yang sangat umum terjadi pada masa bayi awal. Saat ini, Kartu Warna Tinja telah diperkenalkan sebagai alat deteksi dini penyakit bilier atresia pada bayi yang dapat mendiagnosis lebih awal, mempersingkat waktu perawatan bedah, dan meningkatkan prognosis jangka panjang anak dengan atresia bilier.

Namun demikian, diagnosis awal atresia bilier masih menantang. Keterlambatan diagnosis atresia bilier menjadi masalah utama, khususnya di Indonesia. Kurangnya pengetahuan dan kesadaran tentang deteksi dini atresia bilier di antara penyedia layanan kesehatan primer adalah penyebab penting keterlambatan diagnosis atresia bilier. Pada studi terdapat 252 peserta yang terlibat, usia rata-rata peserta adalah 40,7 ± 9,4 tahun. Sebagian besar peserta adalah bidan (61,9%) dan 77,8% peserta telah bekerja di pelayanan kesehatan primer > 5 tahun. 40,5% peserta menyatakan bahwa bayi baru lahir dapat mengalami ikterus fisiologis, yang ditandai dengan sklera ikterik, feses pucat, dan urin berwarna gelap. Sebanyak 27,4% dan 24,2% partisipan mengatakan bahwa semua penyakit kuning pada bayi baru lahir akan selalu membaik dengan sendirinya dan bayi baru lahir dengan penyakit kuning yang berkepanjangan masing-masing tidak memerlukan pemeriksaan lebih lanjut. Terdapat peningkatan nilai median pada skor pengetahuan pretest dan posttest setelah pendidikan kesehatan intervensi (p < 0,05).

Petugas kesehatan primer memahami tentang atresia bilier, namun pengetahuan awal tentang deteksi dini atresia bilier tidak merata di semua petugas kesehatan primer. Temuan ini menunjukkan bahwa peningkatan pengetahuan untuk deteksi dini atresia bilier diperlukan. Pendidikan kesehatan dapat digunakan secara efektif dalam meningkatkan pengetahuan tentang atresia bilier.

Penulis: Dr. Bagus Setyoboedi, dr, SpA(K)

Departemen Ilmu Kesehatan Anak

Fakultas Kedokteran Universitas Airlangga        

Disarikan dari artikel dengan judul: “Early detection of biliary atresia in primary health care: still a problem” yang diterbitkan diF1000Research 2022, 11:1245

Link: https://doi.org/10.12688/f1000research.125555.1

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Early Detection of Biliary Atresia in Primary Health Care

Biliary atresia (BA) is the most common cause of pediatric end-stage liver disease and is the leading cause of liver transplantation in children. It remains a challenge for clinicians. BA is found worldwide, with incidence rates of 1 in 10-19,000 in Europe and North America and higher incidence rates of 1 in every 3,000 infants in East Asia. Clinically, in infants with biliary atresia, cholestatic jaundice develops in the first few weeks of life, followed by acholic stools, dark urine, hepatomegaly, poor growth, progressing to cirrhosis, portal hypertension, and liver failure. The symptoms of BA continue to worsen two weeks after birth. It is different from physiological jaundice. Physiological jaundice will improve within two weeks and get better. Meanwhile, in cholestasis that occurs due to biliary atresia, jaundice will worsen. Unfortunately, identification of infants with cholestatic jaundice is quite difficult because it appears similar to physiological jaundice that is very common in early infancy. Currently, the Stool Color Card has been introduced as an early detection tool for biliary atresia in infants, which can diagnose earlier, shorten surgical treatment time, and improve the long-term prognosis of children with biliary atresia.

Unfortunately, early diagnosis of biliary atresia is still challenging. The delay in diagnosing BA is the main problem, especially in Indonesia. The lack of knowledge and awareness about early detection of BA among primary healthcare providers is the important cause of delayed diagnosis of BA. In this study, there were 252 participants involved and the majority (92.9%) were female. The mean age of the participants was 40.7 ± 9.4 years old (Min-Max: 22-71 years old). Most of the participants were midwives (61.9%) with a diploma graduate (82.5%). A total of 77.8% of participants have years of service in primary health care > 5 years. In this study, there were 40.5% of the primary health care provider stated that newborns < 28 days old may have normal (physiological) jaundice, which is characterized by icteric sclera, pale stools, and dark urine. There were 27.4% health care provider showed that all jaundice that occurs in newborn will always improve on their own in this study and 24.2% primary health care provider stated that newborn with prolonged jaundice does not need further examination. There was a significant difference between the pretest and posttest scores, after interventional health education (p < 0,05).

The primary health care provider understands about biliary atresia, however, the initial knowledge about early detection of biliary atresia is not evenly distributed in all primary health care providers. These findings suggest that improving knowledge to early detection of biliary atresia is needed. Health education can be used effectively in increasing knowledge about biliary atresia.

Author: Dr. Bagus Setyoboedi, dr, SpA(K)

Department of Pediatrics

Faculty of Medicine Universitas Airlangga

Summarized from them paper: “Early detection of biliary atresia in primary health care: still a problem” published in F1000Research 2022, 11:1245

Link: https://doi.org/10.12688/f1000research.125555.1

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