Jorge Bezerra

31 statements · 1 topic · summaries given as host listed separately

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In United States and Europe by two weeks of age, if the baby still has jaundice, the pediatrician or whoever's seeing the patient needs to fractionate the Billy Rubin. If the direct or conjugated fraction is up, think about the pathologic jaundice.

quote · Biliary Atresia

MMP7 alone, at a specific curve level, can predict biliary atresia with a positive predictive value of about 96% and negative predictive value of about 98%.

quote · Biliary Atresia

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Jorge's statements about Biliary Atresia 31 statements

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Biliary Atresia - Clinical Practice Updates

Statement In the US and Europe, alpha-1 antitrypsin deficiency is the most common cause of neonatal cholestasis in the differential diagnosis Open

Quotation In United States and Europe by two weeks of age, if the baby still has jaundice, the pediatrician or whoever's seeing the patient needs to fractionate the Billy Rubin. If the direct or conjugated fraction is up, think about the pathologic jaundice. Open

Statement By two weeks of age, if the baby still has jaundice, the pediatrician needs to fractionate the bilirubin; if the direct or conjugated fraction is elevated, think about pathologic jaundice Open

Statement Cutoff values for MMP7 changed depending on reports from Asia, with much lower cutoff levels reported from Taiwan and China Open

Quotation It is very uncommon to have a baby with biliary atresia and a low MMP7. Open

Statement The MMP7 assay is run every other day and is a six-hour assay Open

Statement Liver biopsy has additional value to quantify inflammation and use that information to personalize treatment Open

Biliary Atresia Part II

Statement American Academy of Pediatrics recommends fractionation of bilirubin for any baby with persistent jaundice beyond two weeks of age, with referral to pediatric gastroenterologist if direct bilirubin is elevated Open

Statement Cincinnati protocol: ultrasound and blood work same day, alpha-1 antitrypsin testing, liver biopsy if alpha-1 normal and acholic stool present, decision on Kasai within 5-7 days Open

Quotation If they say the baby has normal stool color, we want to see it because there have been many cases in which the parents thought it was okay, but to us it was a colic stool. Open

Statement Parents reporting normal stool color must show the stool for verification, as many parents misidentify acholic stools as normal Open

Quotation If they say the baby has normal stool color, we want to see it because there have been many cases in which the parents thought it was okay, but to us it was a colic stool. Open

Statement Parents reporting normal stool color must show the stool for verification, as many parents misidentify acholic stools as normal Open

Quotation MMP7 alone, at a specific curve level, can predict biliary atresia with a positive predictive value of about 96% and negative predictive value of about 98%. Open

Statement MMP7 (matrix metalloprotein 7) ELISA on serum predicts biliary atresia with 96% positive predictive value and 98% negative predictive value in Wuhan cohort study (in press) Open

Quotation MMP7 alone, at a specific curve level, can predict biliary atresia with a positive predictive value of about 96% and negative predictive value of about 98%. Open

Statement START trial (US multicenter, double-blind, placebo-controlled): no significant difference in jaundice clearance at 6 months between steroid and placebo groups in all comers (58% vs 48%, p>0.05) Open

Statement Davenport UK trial showed improvement in jaundice clearance and decrease in bilirubin and liver enzymes with high-dose steroids versus no steroid Open

Statement START trial design was adequately powered as designed; randomized phase had N=70 per arm, larger than Davenport's randomized phase (N=18 steroid, N=19 placebo) Open

Statement START trial documented that serious adverse events occurred earlier in steroid group compared to placebo during the period of steroid administration, but no difference in total SAE frequency Open

Statement Aggressive nutrition management is key: maintain adequate weight gain with concentrated formula or NG supplementation as needed, plus fat-soluble vitamin replacement Open

Statement For patients who never clear jaundice post-Kasai: focus on aggressive nutrition and proceed to liver transplant evaluation; nutritional support is key driver in determining post-transplant complications Open

Statement Cincinnati has unpublished animal model data showing targeted anti-fibrotic therapy produces remarkable decrease in collagen deposition and hepatic fibrosis Open

Summaries Jorge gave as host · 2 summaries

Recaps of other experts' statements, not Jorge's own clinical position.

Summaries Jorge gave as host · Biliary Atresia 2 summaries

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Biliary Atresia Part II

Host summary Jorge Bezerra summarizes what Dr. Mark Davenport said: Davenport UK trial showed improvement in jaundice clearance and decrease in bilirubin and liver enzymes with high-dose steroids versus no steroid Open

Host summary Jorge Bezerra summarizing the discussion: START trial (US multicenter, double-blind, placebo-controlled): no significant difference in jaundice clearance at 6 months between steroid and placebo groups in all comers (58% vs 48%, p>0.05) Open