From cards to code: Reviving Europe's battle against biliary atresia

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, published in the World Journal of Pediatric Surgery, 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 literature 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 health care 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.

More information:
Barbara E Wildhaber et al, European strategies in the screening of biliary atresia: a scoping review, World Journal of Pediatric Surgery (2025). DOI: 10.1136/wjps-2025-001026

Provided by Chinese Academy of Sciences