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How reliably can paediatric professionals identify pale stool from cholestatic newborns?
  1. B Bakshi1,
  2. A Sutcliffe2,
  3. M Akindolie1,
  4. B Vadamalayan1,
  5. S John3,
  6. C Arkley4,
  7. L D Griffin5,
  8. A Baker1
  1. 1King's College Hospital, London, UK
  2. 2Institute of Child Health, University College London, London, UK
  3. 3Greenwich Teaching PCT, London, UK
  4. 4Children's Liver Disease Foundation, Birmingham, UK
  5. 5University College London, London, UK
  1. Correspondence to Dr Alastair Baker, Consultant Paediatric Hepatologist, Paediatric Liver Unit, King's College Hospital, Denmark Hill, London SE5 9RS, UK; alastair.baker{at}


Background The success of surgery in infants with hepatobiliary disease is inversely proportional to the age when surgery was performed. Pale stool colour is a major indicator of biliary obstruction. However, simple recognition has been inadequate, resulting in late diagnosis and referral.

Objective To assess the skills of healthcare professionals in recognising pale stools.

Method Photographs of normal, acholic and indeterminate infant stools were shown to paediatric professionals who have regular contact with jaundiced babies at three London teaching hospitals. Each stool was classified as ‘healthy’ or ‘suspect’.

Results One-third of the stools were not correctly identified by physicians and nurses.

Conclusion Experienced professionals often do not recognise stool colour associated with biliary obstruction. The authors propose that stool colour cards similar to those used in Japan and Taiwan may improve early detection of hepatobiliary disease at a minimal cost.

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  • Competing interests None.

  • Ethics approval This study was conducted with the approval of The Royal Free and University College School of Medicine Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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