From cards to code: reviving Europe’s battle against biliary atresia

Biliary atresia (BA) is the leading cause of pediatric liver transplants and often goes undiagnosed until it’s too late. With a short window for effective surgical intervention—ideally before 60 days of age—early detection is critical. While some countries have pioneered simple yet effective screening tools such as stool color cards (SCC), Europe’s efforts remain fragmented. Due to inconsistent practices, parental unawareness, and physician hesitancy, many infants continue to miss this crucial period. A previous study finds that despite proven techniques and emerging digital innovations, most European nations have yet to implement national BA screening programs. The authors call for a unified approach that merges cost-effective tools with innovation to ensure timely diagnoses and improved outcomes for vulnerable infants.

Published (DOI: 10.1136/wjps-2025-001026) on May 12, 2025, in World Journal of Pediatric Surgery, researchers from Geneva University Hospitals conducted the first scoping review of BA screening efforts across Europe. Their findings reveal a patchwork landscape: while countries like Switzerland, France, and Germany have introduced national SCC programs, most others lag behind or rely solely on localized pilots. This review highlights both systemic inertia and promising technologies—such as AI-enabled apps—that could bridge the gap in diagnosis and care, advocating for Europe to rethink and revitalize its approach to neonatal liver screening.

This review assessed a wide range of data—from published literatures to digital health tools—on three major screening strategies: SCC, serum bilirubin testing, and biochemical profiling. Switzerland was the first country in Europe to launch a national SCC program, reducing the median age of surgery and eventually integrating the card into newborn health booklets. France followed through a parent-led advocacy campaign, while Germany only recently mandated SCC use nationwide. Elsewhere, efforts remain sporadic. Studies consistently show SCC’s effectiveness improves dramatically when accompanied by clear referral guidance. Yet many pediatricians still resist its use, citing workload and psychological concerns. Meanwhile, the UK has led research on bilirubin screening, showing exceptional accuracy—but has failed to move from research to policy due to logistical and financial barriers. Recent breakthroughs such as Italy’s PopòApp and Germany’s AI-powered stool image analysis show strong potential for improving accuracy and scalability. Together, these insights suggest that Europe has both the tools and the knowledge—but not yet the will—to implement widespread BA screening.

“Europe has no shortage of expertise, evidence, or technology—what’s missing is coordinated action,” said Professor Barbara E. Wildhaber, senior author of this study. “We’ve seen how something as simple as a color card can shift outcomes dramatically. Add digital tools and clinical buy-in, and we could revolutionize early diagnosis for thousands of infants. But time is of the essence—each delay costs lives.”

A unified European strategy could turn the tide against BA-related infant mortality. Combining SCC with digital apps and AI can provide low-cost, high-reach solutions for families and frontline clinicians. Serum bilirubin testing, though more expensive, captures a wider spectrum of liver diseases and could complement SCC-based programs. Countries may benefit most from hybrid screening models tailored to their healthcare infrastructure. Crucially, any technical rollout must be paired with education, awareness, and strong political advocacy. With the right alignment of tools, policy, and public will, Europe can catch up—and catch the infants who need help most.

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References

DOI

10.1136/wjps-2025-001026

Original Source URL

https://doi.org/10.1136/wjps-2025-001026

About World Journal of Pediatric Surgery

World Journal of Pediatric Surgery is an international open access journal publishing original researches, reviews, perspectives and short reports on all aspects of pediatric surgery. The journal is particularly interested in interdisciplinary studies including, but not limited to, minimally invasive surgery, robotic surgery, precision surgery, artificial intelligence, new materials and medical instruments.