PEDIATRICS Vol. 97 No. 6 June 1996, pp. 828-831
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Biliary Atresia, Cytomegalovirus, and Age at Referral

Phillip I. Tarr MD1, Joel E. Haas MD2, and Dennis L. Christie MD3

1 Division of Gastroenterology, Department of Pediatrics, University of Washington School of Medicine and the Children's Hospital and Medical Center, Seattle; Department of Microbiology, University of washington School of Medicine, Seattle
2 Department of Pathology, children's Hospital of Michigan, Detroit
3 Division of Gastroenterology, Department of Pediatrics, University of Washington School of Medicine and the Children's Hospital and Medical Center, Seattle

Objective. To determine the frequency with which patients with extrahepatic biliary atresia (EHBA) are infected with cytomegalovirus (CMV) and to ascertain the age at referral to a specialty center for surgical correction of EHBA.

Methods. The charts of all patients discharged from the Children's Hospital and Medical Center between July 1, 1989 and December 31, 1993 with a new diagnosis of EHBA were reviewed to determine the frequency with which EHBA was accompanied by CMV infection. Data analyzed included age at referral and sex of patients, histopathologic evidence of CMV infection and size of bile ducts in the resected liver, and serologic (IgM) or culture diagnosis of CMV infection.

Results. Twenty-three patients with EHBA were evaluated at Children's Hospital and Medical Center in the study period. Twenty-one of the patients with EHBA were appropriately evaluated for infection with CMV and infection was documented in 5 (24%) patients. The median age of referral for all patients was 61 days (range 10 to 124 days). Infected patients were referred later (82.4 ± 28.7 days) than noninfected patients (48.8 ± 21.8 days) (P = .01) and were more likely to be girls, but the medians of the diameters of the bile ducts in the resected porta hepatis were similar. Viral inclusions were not identified in any of the liver specimens.

Conclusions. CMV infection is present in an unexpectedly large proportion of patients with EHBA at the time of referral. The establishment of CMV infection in infants with cholestasis should not deter the search for EHBA. Physicians should strive to reduce the age of referral of patients with EHBA to pediatric surgical centers by evaluating infants who remained jaundiced at 4 weeks of age.

Submitted on February 13, 1995
Accepted on August 14, 1995