A Hierarchical Linear Model Analysis of Survival Factors Related to Biliary Atresia Infants–the Contextual Effects Analysis
Date Issued
2016
Date
2016
Author(s)
Hsu, Sandy Huey-Jen
Abstract
Background: Neonatal jaundice is a common problem during infancy. Recently due to the active promotion of breast feeding by the Ministry of Health and Welfare, breast feeding rates in infants has increased markedly. Consequently, prolonged jaundice beyond 2 to 4 weeks of life is quite common. Biliary atresia is the most common cause of extra-hepatic cholestasis in infancy, and is the leading cause of childhood death due to liver disease. Although part of the prolonged jaundice in infancy is caused by cholestasis, it is often unrecognized and mixed up with breast feeding jaundice, resulting in delays for the child during the optimal treatment time, ultimately leading to poor outcomes. The first universal screening system using infant stool cards was established in Taiwan in 2004. However, it is still not a well known system, nor is it widely used by medical personnel and the care takers, may result in poorer outcomes of biliary atresia infants. Aims: To investigate the effects of individual-level and hospital-level variables, as well as cross-level effects on survival factors of biliary atresia infants. Methods: We enrolled 381 infant with biliary atresia who were born between 2002 and 2014 and were registered on the Taiwan Children Liver Foundation (TCLF) database in this study. Descriptive statistics, independent t-test, One-way Analysis of Variance (One way ANOVA) Pearson correlation test, survival analysis and Hierarchical Linear Modeling were conducted. Results: We identified children through early detection and diagnosis after birth, and found that children who underwent a Kasai operation earlier on in their diagnosis resultd in significant improvements in the overall prognosis of these children. Preterm delivery utilmately delays the Kasai operation time resulting in a poor prognosis of biliary atresia infants. Children who were born in hospitals or clinics with pediatricians will accept Kasai surgery early. However, we discovered that the cross-level interaction of premature biliary atresia infant and professional pediatricians will significantly delay the optimal Kasai operation time leading to poorer outcomes. Conclusion: Different individual-level and hospital-level variables were related to outcomes of biliary atresia infants.
Subjects
Biliary atresia
Kasai operation
Native liver survival
Survival Analysis
Hierarchical Linear Modeling (HLM)
Type
thesis
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