AUTHOR=Fang Heping , Li Zehao , Xian Ruoling , Yin Yu , Wang Juan , Guo Hongling , Dai Xiaoke , Zhang Mingman , Hu Yan , Li Yingcun 

TITLE=Early life growth and developmental trajectory in children with biliary atresia undergoing primary liver transplantation

JOURNAL=Frontiers in Pediatrics

VOLUME=11

YEAR=2023

URL=https://www.frontiersin.org/journals/pediatrics/articles/10.3389/fped.2023.1198360

DOI=10.3389/fped.2023.1198360

ISSN=2296-2360

ABSTRACT=<sec><title>Objective</title><p>To clarify the early growth and developmental characteristics of children with biliary atresia (BA) undergoing primary liver transplantation (pLT).</p></sec><sec><title>Methods</title><p>A prospective cohort study, which specifically focused on BA-pLT children, was conducted after the diagnosis of BA by following the children at the time of pLT and 1, 3, 5, 7 months and 1 year after pLT for growth and developmental monitoring. The growth parameters were calculated according to the WHO standard, and the developmental status was assessed using Denver Developmental Screening Tests.</p></sec><sec><title>Results</title><p>A total of 48 BA children who received pLT at the age of 5.00 ± 0.94 months were analyzed. The weight-for-age <italic>Z-</italic>value (<italic>Z</italic><sub>W</sub>) and length-for-age <italic>Z</italic>-value (<italic>Z</italic><sub>L</sub>) were higher than the head circumference-for-age <italic>Z-</italic>value (<italic>Z</italic><sub>HC</sub>) at pLT (<italic>P </italic>= 0.002 and 0.02), but they were all lower than the WHO growth standard (<italic>Z</italic> = 0) (<italic>P </italic>&lt; 0.001). The <italic>Z</italic><sub>W</sub> and <italic>Z</italic><sub>HC</sub> decreased first and then returned to the population level at 1 year after pLT, while the <italic>Z</italic><sub>L</sub> only returned to the preoperative status and was lower than the <italic>Z</italic><sub>W</sub> and <italic>Z</italic><sub>HC</sub> (<italic>P </italic>&lt; 0.001). Developmental screening showed that 35% (17/48) of the children were defined as suspicious and 15% (7/48) were abnormal at 1–4 months after pLT, the most likely time to be suspected of developmental delay. At 1 year after pLT, gross motor skill delay still existed (12/45, 27%), and language skill delay began to appear (4/45, 9%).</p></sec><sec><title>Conclusions</title><p>BA-pLT children suffer from growth and developmental problems. Low <italic>Z</italic><sub>HC</sub> is the main growth problem before pLT, while low <italic>Z</italic><sub>L</sub> is the problem after pLT. Developmental delays are significant after pLT, especially in motor and language skills. The current study suggested that further studies are warranted to clarify the long-term growth and developmental outcomes of BA-pLT children, to compare them with children undergoing the Kasai procedure and to explore their influencing factors and possible mechanisms.</p></sec>