Biliary Atresia Linked to Autism and Neurodevelopment Delays
METHODOLOGY:
Researchers conducted a single-centre observational study to examine general and autism-related neurodevelopment in infants with BA.
Surveys on neurodevelopment were completed by 107 parents of children with BA (mean age, 7.8 years; range, 7 months to 12 years; 50% post-transplant).
A total of 50 infants with BA younger than 5 years (median age, 2.3 years) were compared with the reference group of 93 age- and sex-matched infants, comprising 50 with a low likelihood (no neurodevelopmental risk) and 43 with a high likelihood (having a first-degree relative with autism and/or attention-deficit/hyperactivity disorder) for neurodevelopmental conditions.
General neurodevelopment was assessed using the Mullen Scales of Early Learning (MSEL) and Vineland Adaptive Behavior Scale (VABS); autism-related behaviours were evaluated using the Autism Diagnostic Observation Schedule, Second Edition (ADOS-2).
Primary objectives were to compare general neurodevelopmental outcomes between infants with BA and two reference cohorts and to examine the relationship of neurodevelopment to key disease-related factors.
TAKEAWAY:
Neurodevelopmental concerns were reported by 37% of parents in their child with BA, with 47% requiring at least one support service (most commonly speech and language therapy [20%]), and independently noted by professionals in 28% of cases.
Boys with BA were disproportionately affected, with 69% of them scored above the cutoff for autism (t(18) = 3.44; P < .001).
< .001). Children with BA showed significantly lower cognitive and adaptive functioning than both low- and high-likelihood reference groups (VABS: F = 18.26; MSEL: F = 9.981; P < .001 for both).
< .001 for both). Earlier Kasai surgery ( P = .047) and jaundice clearance at 1 month post-surgery ( P = .012) were significantly associated with better general neurodevelopmental outcomes (F = 2.428; P = .042), but not with the presence of autism-related traits.
IN PRACTICE:
"High levels of neurodevelopmental difficulties in children with BA reveal a need for greater awareness and enhanced surveillance. That early identification and treatment of BA is linked to better general neurodevelopmental outcome and encourages proactive management," the authors wrote.
SOURCE:
This study was led by M. Earl, PhD, Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England. It was published online on May 28, 2025, in The Journal of Pediatrics .
LIMITATIONS:
This study was limited by statistical power and generalisability for subgroup analyses because of the modest sample size. The cross-sectional design captured a snapshot of neurodevelopment but did not account for potential worsening over time. Pandemic-related constraints prevented ADOS-2 assessments in nine eligible infants, potentially underestimating the prevalence of autism traits.
DISCLOSURES:
This study received funding from MowatLabs, King's College Hospital, National Institute for Health and Care Research Maudsley Biomedical Research Centre at South London and Maudsley National Health Service Foundation Trust, and King's College London. The authors declared having no conflicts of interest.
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