Table 1.

Summary of events

TIME	EVENTS	INVESTIGATIONS
Pregnancy	• Unremarkable pregnancy	Normal screening test results and normal second-trimester ultrasound results
	• Mother receives routine follow-up
Birth	• Spontaneous vaginal delivery at 39 wk, 2 d	None
	• Apgar scores of 9 at 1 and 5 min; BW of 3.770 kg
	• No complications
2 d	• Weight loss of 4.8% of BW	TSB level of 195 μmol/L
	• Child is mildly jaundiced	Conj level of 9 μmol/L
	• Child is discharged
3 d	• Routine visit by nurse (nurse 1) from local community services centre	None
20 d	• First physician visit (physician 1)	Normal examination findings
	• No jaundice noted
41 d	• Call from mother who is concerned about jaundice. Nurse 1 notes yellow and soft stools; child is well	None
	• Mother is reassured
45 d	• Nursing visit. Jaundice of sclera and skin. Child is thriving. Nurse 2 discusses jaundice with physician 2. Diagnosis of breast milk jaundice	None
60 d	• Vaccination visit (nurse 3)	None
69 d	• Mother calls about persistent jaundice	None
	• An appointment is offered for the next d but the mother is not available
	• Follow-up remains as planned
76 d	• Second physician visit (physician 3)	Urgent ultrasound and bloodwork ordered
	• Normal development but substantial jaundice with pale yellow stools, dark urine, and hepatomegaly
78 d	• Laboratory results received	TSB level of 169 μmol/L
	• Child is sent to emergency department for urgent workup	Conj level of 105 μmol/L
		ALT level of 149 IU/L
		AST level of 209 IU/L
83 d	• Portoenterostomy is performed	None
	• Workup confirms diagnosis of biliary atresia

ALT—alanine aminotransferase, AST—aspartate aminotransferase, BW—birth weight, Conj—serum conjugated bilirubin, TSB—total serum bilirubin.