Abstract: Objective:To determine the value of stool color card and bilirubin measurements in biliary atresia(BA) screening. Methods:According to the retrieval method, literature was searched in PubMed, Embase, Medline from the establishment of the database and in the Chinese CBM database from January 1, 2000 to April 26, 2020. Literature was screened and selected based on the inclusion and exclusion criteria set by the ongoing clinical practice guideline on BA. The QUADAS-2 scale was used to evaluate the risk of bias and applicability concerns. Data were extracted and diagnostic parameters were calculated for the combined data. ResultsF:ive studies on stool color card screening were included in this meta-analysis. The combined sensitivity and specificity were 84% (95% CI: 76%-90%) and 100% (95% CI: 100%-100%) respectively with I2 of 0% and 86.37%. The AUC was 0.99 (95% CI: 0.98-1.00). One study was included for bilirubin detection of heel-prick blood by mass spectrum. The sensitivity was 100% (95% CI: 56.1%-100%) and specificity was 99.9% (95% CI: 99.9%-99.9%). Ten studies were included in the liver biopsy meta-study. The combined sensitivity was 96% (95% CI: 91%-98%), specificity was 96% (95% CI: 92%-97%), and the AUC was 0.98 (95% CI: 0.97-0.99). MMP-7 included 4 studies, with sensitivity of 96% (95% CI: 93%-98%) and specificity of 91% (95% CI: 85%-95%). AUC of SROC curve was 0.97 (95% CI: 0.95-0.98). Seven studies were included in meta-analysis of the duodenum drainage fluid study. The combined sensitivity was 96% (95% CI: 92%-96%), specificity was 86% (95% CI: 79%-91%), and the AUC was 0.97 (95% CI: 0.96-0.98). The GGT test included 15 studies. The sensitivity was 81% (95% CI: 73%-88%) and specificity was 79% (95% CI: 72%-84%). The SROC curve showed the area under curve (AUC) was 0.87 (95% CI: 0.83-0.86). Conclusion:Stool color card is a noninvasive, convenient and effective way to screen biliary atresia. Bilirubin measurements from neonatal heel stick, however, need more clinical trials to determine its value in BA screening. Duodenal drainage and liver biopsy are both valuable way to diagnosis BA, but MMP-7 exceeds those tests in its convenience and precision. Although as a clinical routine, GGT tests showed a limited value in diagnosing BA.

Key words: &gamma, Biliary atresia, Bilirubin measurements from neonatal heel stick, Duodenal drainage fluid, -glutamyl transpeptidase, Liver biopsy, Matrix metalloproteinase-7, Stool color card