The UK National Screening Committee (UK NSC) has launched a public consultation on whether all newborns should be screened for biliary atresia, a rare but potentially life-threatening liver condition affecting approximately 1 in 17,000 babies in the UK.^1,2 Without treatment, the disease can quickly lead to liver failure, but early diagnosis and timely surgical intervention (Kasai portoenterostomy) within the first 2 months of life significantly improve outcomes. However, there remains uncertainty over which, if any, screening strategies can reliably achieve early detection at the population level.¹

The consultation follows a 2025 evidence summary, commissioned as part of the committee’s routine screening review process, to assess whether advances in research now justify a national screening programme. The review examined two main approaches: laboratory testing using dried blood spots collected during the routine newborn heel‑prick, and parent‑led stool colour card (SCC) programmes designed to flag pale stools, an early sign of the condition.¹

While both approaches show promise, the evidence review concluded that neither currently meets the UK NSC’s standards for population screening. For laboratory biomarkers, early pilot work found that matrix metalloproteinase‑7 (MMP‑7) levels in dried blood spots could distinguish infants with biliary atresia from others with high sensitivity and specificity in small cohorts.³ However, more recent analyses suggest that even elevated MMP‑7 levels may not deliver sufficient performance in real‑world screening settings without further validation.⁴ Research using targeted metabolomics of dried blood spots has also identified potential markers, but these remain at a preliminary stage.⁵

Evidence on SCCs also indicates variable effectiveness: systematic analyses suggest that stool colour charts may detect biliary atresia with moderate accuracy, but findings vary across populations and study designs.⁶ Moreover, countries that use SCC screening do not consistently achieve earlier surgery compared with current UK practice.¹

As a result, the UK NSC is not recommending the introduction of universal screening at this stage. Instead, it is inviting clinicians, researchers, patient groups and members of the public to comment on the findings and submit additional evidence by 20 May 2026.¹

The consultation reflects the committee’s cautious, evidence‑led approach, recognizing the serious impact of biliary atresia, while emphasizing the need for reliable tests that clearly improve outcomes before expanding the national newborn screening programme.¹

References

1. UK National Screening Committee. UK NSC consults on screening for biliary atresia in newborns. Available at: https://nationalscreening.blog.gov.uk/2026/02/25/uk-nsc-consults-on-screening-for-biliary-atresia-in-newborns/ (accessed 3 March 2026).
2. Livesey E, Cortina Borja M, Sharif K, et al. Epidemiology of biliary atresia in England and Wales (1999-2006). Arch Dis Child Fetal Neonatal Ed. 2009;94(6):F451-5. doi: 10.1136/adc.2009.159780.
3. Lee CS, Ni YH, Chen HL, et al. A Pilot Study of Biliary Atresia Newborn Screening Using Dried Blood Spot Matrix Metalloproteinase-7. J Pediatr Gastroenterol Nutr. 2023;76(4):418-423. doi: 10.1097/MPG.0000000000003701.
4. Uecker M, Bulitta B, Janzen N, et al. Measuring MMP-7 levels in dried blood spots appears not feasible for newborn screening of biliary atresia. Hepatol Commun. 2026;10(2):e0896. doi: 10.1097/HC9.0000000000000896.
5. Xiao Y, Zhou Y, Zhou K, Cai W. Targeted Metabolomics Reveals Birth Screening Biomarkers for Biliary Atresia in Dried Blood Spots. J Proteome Res. 2022 Mar 4;21(3):721-726. doi: 10.1021/acs.jproteome.1c00775. Epub 2021 Dec 1. PMID: 34850627.
6. Arshad A, Gardiner J, Ho C, et al. Population-based screening methods in biliary atresia: a systematic review and meta-analysis. Arch Dis Child. 2023;108(6):468-473. doi: 10.1136/archdischild-2022-324946.