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Biliary atresia (BA) is a time-critical cause of neonatal cholestasis, where early Kasai portoenterostomy markedly improves outcomes. Given that 2–15% of newborns in the United Kingdom remain jaundiced beyond 14 days of life, 1 an efficient triage strategy is essential to identify high-risk infants who warrant urgent evaluation at tertiary hepatobiliary centres.A retrospective analysis was conducted of all infants referred with prolonged neonatal jaundice a major tertiary paediatric liver unit between January 2023 and September 2025. Diagnostic performance of clinical, biochemical, and ultrasonographic parameters was assessed against the gold-standard intraoperative cholangiogram for BA confirmation. Continuous and categorical variables were compared using the Student’s t-test and χ2 test, respectively, and diagnostic accuracy was quantified using the area under the receiver operating characteristic curve (AUROC). A composite predictive index, the Simple Biliary Atresia Score (SBAS),2 integrating laboratory and imaging features was validated.Forty-eight infants (median referral age: 42 days) were included, of whom 19 (39.6%) had biliary atresia. The mean total bilirubin level at referral was 140.5 µmol/L. Among non-invasive modalities, the presence of acholic stools demonstrated the highest diagnostic accuracy for BA (AUROC = 0.819) (see table 1). Other parameters—including the direct-to-total bilirubin ratio, triangular cord sign, absent gallbladder, and pre-portal vein echogenicity—showed moderate predictive performance (AUROC = 0.614–0.760). Integration of these metrics into the Simple Biliary Atresia Score substantially improved overall diagnostic discrimination.The Simple Biliary Atresia Score (SBAS) is a clinically practical and accurate composite tool for triaging infants with cholestasis. Incorporating non-invasive laboratory and ultrasonographic findings enhances early identification of biliary atresia and optimizes referral timing for surgical evaluation.References Hannam S, McDonnell M, Rennie J M. Investigation of prolonged neonatal jaundice. Acta Paediatrica 2000;89(6):694-7. doi: 10.1080/080352500750044025.Toh Q, Chen Y, Lee YY. Simple biliary atresia score - a validated diagnostic aid for infantile cholestasis. Pediatric Surgery International 2024;40:212.Abstract OC31 Table 1Patient variables