Background

Biliary atresia (BA) is a disease of infancy which, if untreated, is fatal. When diagnosed, an attempt is made to restore bile flow by excision of the affected biliary remnants and portoenterostomy.1 The baby's age at surgery is critical to the outcome, forestalling or removing the need for liver transplantation.2

BA presents as a combination of prolonged neonatal jaundice, pale stools and dark urine. Jaundice is a key clinical sign that is detectable first in the sclera and with increasing severity in the skin. Despite conventional clinical teaching that recommends scleral examination to demonstrate jaundice, healthcare professionals comment on …