Purpose: Biliary atresia (BA) remains the most common condition leading to liver transplantation in children, with various potential aetiological factors implicated in its development. We hypothesised that as a result of the COVID-19 pandemic, (1) case numbers may have decreased due to reduced exposure to pathogens and (2) age at presentation may have increased due to strict social distancing and public health measures. Methodology: A retrospective cohort study was performed of all infants with BA managed at the Sydney Children’s Hospital Network during the period March 2017 – March 2023. Case numbers of BA as well as age at Kasai portoenterostomy (KPE), native liver survival (NLS), and rates of primary transplant without initial Kasai were analysed across three time periods, ‘pre-COVID’ (prior to implementation of lockdowns and social distancing), ‘COVID’, and ‘post-COVID’. Results: A total of 55 infants with BA presented during the study period; a mean of 12.3 per year during the pre-COVID period, 4 during COVID and 10 during the post-COVID period. 50/55 proceeded to KPE with 5 undergoing primary liver transplant due to delayed presentation with cirrhosis. Of these 5, one presented prior to the COVID period, with three presenting during COVID lockdowns and one following cessation of lockdown. The median age at time of KPE was similar across the time periods (ranging from 39 – 61 days). NLS at 12 and 24 months was also similar between time periods, with age at time of Kasai being a strong predictor of NLS. Conclusion: Although numbers overall were low, case numbers of BA in NSW were lower during COVID lockdowns. Primary transplant without initial KPE also appeared to increase during this time period, demonstrating a potential delay in presentation. Native liver survival was similar across time periods, with age at KPE being more predictive of NLS.