Tohoku J. Exp. Med., 2020 December, 252(4)

Repeatability and Reliability of Home-Based Stool Color Card Screening for Biliary Atresia Based on Results in China and Japan

YAN-HONG GU,¹ JIN-QI ZHAO,² YUAN-YUAN KONG,² HAI-HE YANG,² MEI DIAO,³ LONG LI,³ SHOSUKE NOMACHI,⁴ MICHIKO TEZUKA,⁴ JUNJI HANAI⁵ and AKIRA MATSUI⁶

¹Department of Hygiene and Public Health, Osaka Medical College, Takatsuki, Osaka, Japan
²Department of Newborn Screening, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
³Department of Surgery, Capital Institute of Pediatrics, Beijing, China
⁴Health and Science Section (Maternal and Child Screening), Sapporo City Institute of Public Health, Sapporo, Hokkaido, Japan
⁵Hokkaido Pharmaceutical Association Public Health Examination Center, Sapporo, Hokkaido, Japan
⁶Department of Hepatology, National Medical Center for Children and Mothers, National Center for Child Health and Development, Tokyo, Japan

Biliary atresia (BA) is the most frequent hepatic cause of death in early childhood. Early referral and timely Kasai portoenterostomy are essential for the improvement of long-term native liver survival rate of BA patients. Screening with stool color card (SCC) has been implemented in Japan since 1994. Recently current digital edition of SCC consisted of seven digitally created images was introduced to China. Our study aimed to evaluate the repeatability and reliability of same edition of SCC used in Beijing, China and Sapporo, Japan. In Beijing from 2013 to 2014, SCCs were distributed to infants�f guardians by trained nurses in maternal facilities during information sessions on neonatal screening programs. SCC was used at three checkpoints for each infant after birth for screening. The SCC data were collected from 27,561 infants (92.5%) in Beijing by 42-day health checkup, mobile phone and social network services. In Sapporo from 2012 to 2015, the SCCs with a postcard and guardian instructions were inserted into Maternal and Child Health Handbook and distributed to all pregnant women. The data were collected from a total of 37,478 (94.3%) infants in Sapporo via the postcard during the 1^st month infant health checkup. We thus identified two BA patients in Sapporo and two BA patients in Beijing. High rates of sensitivity and specificity in both cities were observed. The frequency distribution of color images on SCC reported in both cities was similar. This study shows excellent repeatability and reliability of the current digital edition of SCC.