Early Detection of Neonatal Cholestasis: Inadequate Assessment of Stool Color by Parents and Primary Healthcare Doctors

Mauri Witt*, Jeanet Lindeboom, Corry Wijnja, Anneke Kesler, Claudia M. G. Keyzer-Dekker, Henkjan J. Verkade, Jan B. F. Hulscher

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

13 Citations (Scopus)


IntroductionEarly diagnosis and surgery (<60 days of age) improve outcomes in children with biliary atresia. Only 56% of patients undergo timely surgery in the Netherlands. Lack of acquaintance with symptoms such as discolored stools might underlie this delay. We analyzed whether Dutch parents, youth healthcare doctors, or general practitioners recognized discolored stools and evaluated the effect of the Infant Stool Color Card (ISCC) on recognizing discolored stools.

Material and MethodsWe asked 100 parents, 33 youth healthcare doctors, and 50 general practitioners to classify photographs of stools as normal or abnormal. Subsequently, we asked whether parents would seek medical help and doctors would refer the patient for medical investigation. Finally, parents scored stools using the ISCC.

ResultsTwo-third of both parents and youth healthcare doctors recognized all discolored stools. Only half of them would seek medical help for all discolored stools resp. refer patient for medical investigation. Only one-third of the general practitioners recognized all discolored stools and would refer for medical investigation for all discolored stools. Using the ISCC, the percentage of parents recognizing all discolored stool increased from 66 to 87% (p

ConclusionNeither parents nor youth healthcare doctors nor general practitioners reliably recognize discolored stool. The ISCC is an effective screening method for discolored stool. Our data indicate that the ISCC should be accompanied by unequivocal advices regarding referral for medical investigation upon detection of discolored stools.

Original languageEnglish
Pages (from-to)67-73
Number of pages7
JournalEuropean Journal of Pediatric Surgery
Issue number1
Publication statusPublished - Feb-2016


  • neonatal cholestasis
  • biliary atresia
  • Infant Stool Color Card
  • discolored
  • stools

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