DIAGNOSIS AND TREATMENT of Hyperbilirubinemia.

[@bayanalzaher539]

Dr.Tala, I am a pediatric resident, I adore you and I like your lectures, they are amazing and very clear, and to the point. After watching them I feel very confident about the topic. Thank you so much, Bayan.

[@TalaTalksNICU]

Hello Dr. Alzaher. Thank you so much for the lovely compliment. Words like yours have really kept us going. Let us know what else you'd like to see and we'll add it to the list :)

[@anaherpes2501]

I cannot thank #Doctorojie for curing my herpes virus completely ..

[@abubekerjemal6950]

I watched the 4 lectures in the morning and I came back to thank you. Thank you so much, you saved me hours of thorough reading. From Ethiopia 🇪🇹

[@TalaTalksNICU]

Oh so glad that you found them helpful! I'm sure there's a lot we didn't cover that you'd still benefit from reading (this definitely doesn't cover everything!!). Thanks so much for watching!!

[@erikam5461]

I’m a new grad nicu nurse and your videos are so helpful in understanding what is happening with the babies I take care of. They are very easy to understand. Thank you!

[@TalaTalksNICU]

Thank you SO much Erika- what a lovely comment to read. And we're so glad they're easy to understand- always our goal! WE hope you love your time in the NICU!

[@nicurn5030]

AND I THOUGHT I KNEW HYPERBILIRUBINEMIA.! BEAUTIFULLY AND SO THOROUGHLY EXPLAINED AS USUAL.WORKED WITH DR BHUTANI FOR A FEW YEARS AND HIS GRAPH WAS VERY USEFUL BUT I FEEL LIKE YOUR LECTURE WAS THE MISSING LINK !THANK YOU SO MUCH.

[@TalaTalksNICU]

Feel like we can stop now after that comment! Must have been fascinating to work with Dr. Bhutani! Your comments always make us SO happy. Thank you again :)

[@naitramsingh6942]

Hello Dr Tala, amazing video with clean concise explanations, i am really thankful for your efforts, do continue the wonderful work

[@TalaTalksNICU]

Thank you so much Naitram for watching and for taking the time to comment. We really appreciate it!

[@fidesminervaballon6028]

Dr. Tala thank you so much for all the info! You and your team is really doing a great job. It is easier to study and learn from your explanation. Will be watching more of your videos. Fides

[@TalaTalksNICU]

Dear Fides, thank you so much for both watching and for writing to us. We are so happy it's helping your studying :)

[@sehrishgul5389]

I am watching it for the second time! Wonderful lecture. You explain really well. Thank you very much!

[@TalaTalksNICU]

Thank you so much Sehrish. We appreciate you taking the time to write something :)

[@anaherpes2501]

I cannot thank #Doctorojie for curing my herpes virus completely ..

[@lovescotland7943]

Great video. I’m training to be an advanced nurse practitioner in the uk and your videos are so helpful. Thank you.

[@TalaTalksNICU]

We’re so glad they’re helpful to you. Really appreciate you taking the time to let us know :)

[@tchiotchoumba9228]

Hello Dr Tala. i love love love your videos. please never stop making them

[@TalaTalksNICU]

Thank you so much Tchio! We are enjoying the process, and LOVINg all the positive feedback from the community. Thanks for being here :)

[@chestermudehwe3755]

your lectures are clear and very easy to understand

[@TalaTalksNICU]

Thanks so much! Exactly what we were aiming for! Thank you

[@veenamary5442]

Thankyou Mam for this amazing vedio . I Like all your vedios.They are so easy to understand so informative .

[@TalaTalksNICU]

Thank you for your lovely comment. So happy you find them helpful!

[@Kinfe12]

Thank you it was very informative and condensed lecture. Lucky me I assisted an exchange transfusion procedure while i was on my 3rd year of medical college

[@TalaTalksNICU]

Thanks for the lovely comment doc! That's great you got to do that procedure- it's really good experience. Good luck in the rest of your studies :)

[@rejithamaniyan598]

Hai... Dr.Tala great job. Thank you.

[@TalaTalksNICU]

Hello! Thanks so much for watching and for your lovely comment!

[@donnamiller3687]

Could you do a video on Fetal Alcohol Spectrum Disorder and Neonatal Abstinence Syndrome please. I love your videos and find them incredibly helpful!

[@TalaTalksNICU]

Hello Donna. We didn't have FAS on our list- so thank you so much for suggesting this topic. And yes- we definitely need to do NAS too. Especially since there has been a slight change in recent years on how to treat these infants. Thank you!

[@stillbreathing100]

Thanks for this kindness! Brilliantly delivered. Any role of giving iv albumin in the treatment?

[@TalaTalksNICU]

Another excellent question. This has been discussed in the past- but the truth is the role of albumin in neonatology has always been a grey topic. (Does it really stay in the blood vessels at all?) Maybe in a tiny, preemie sick baby with a super high bilirubin and a super low albumin, you'd consider it (if a DVET was just too much). Otherwise, really no.

[@amirulislam9196]

excellent

[@TalaTalksNICU]

Thanks so much :)

[@mwewachansa9959]

wonderful lecture, well explained

[@TalaTalksNICU]

Thank you so much for letting us know - we really appreciate you being here :)

[@mwewachansa9959]

@@TalaTalksNICU I'm a neonatal nurse student,I would like you to a lecture on seizures and gastroschisis

[@TalaTalksNICU]

Hello!! Yes!!! We need to cover both of those topics. Thanks so much for the suggestions :)

[@beverlykwashie1654]

Hi Dr. Tala, amazing videos. would love if you can do video on NEC, Birth trauma etc. Your videos make studying easy. Thank You

[@TalaTalksNICU]

Hello! thanks so much for your lovely compliment! NEC is coming soon (after high frequency ventilation). What types of birth traumas do you mean? Generally injuries that can happen (Erbs palsy/ clavicular fractures etc.) or something else?

[@ayesha1708]

Thanks for your videos , REALLY helpful , I was wondering if there is one coming on inotropes anytime ? That's another good topic if possible :D

[@TalaTalksNICU]

Hi Ayesha! Glad you're still watching :) A video on inotropes is a great idea! I do kind of feel like there's so much we don't know about pressors that the ones we all end up using are institution dependent. So maybe it will be more of a general lecture- mechanism of action etc.! Thank you!!

[@naeemakhtaraneesahmed779]

Very nice and thank you so much

[@TalaTalksNICU]

Thank you so much for being here and taking the time to comment!

[@janeg7830]

Hello! Thanks for all the videos on bilirubin. Why do babies display lethargy when they have high bilirubin levels?

[@TalaTalksNICU]

Great question- it's because some of the bilirubin is getting through (not enough to cause permanent damage). But it's toxic to the cells and once babies have lethargy is a very quick slide down to damage (tiredness--> eat less--> hyper bili). I'm sure there are a billion more biochemical processes going on- but I'm accepting that level of understanding!

[@jessicahirschel9300]

Hi, sorry I have another question ;-): Parallel to hydrate and treat with phototherapy, would you give IV albumine? Thank you so much!

[@TalaTalksNICU]

Great question Jessica! There’s lots of controversy about giving albumin in general. When albumin is low the capillaries are generally leaky- so we worry that giving more albumin would just result in more leakage outside the blood (eg into the lungs). There are one off cases we’d give it though- and I can imagine a super sick patient with hypoalbuminia and super high indirect bili where we would consider it!!!

[@osamaalagamawy3891]

ما شاء الله. بارك اللة فيكى

[@TalaTalksNICU]

We love that you've been watching all these videos-thad you for being such a great supporter )

[@TS-kl8zg]

Dr. Tala, thank you so much. I really enjoy learning with you! If you or your wonderful team could clarify: How soon would we see an increase in reticulocytes in a babe with hemolytic jd?? What about prem, do we normally see high reticulocytes in their normal cbc? Thank you kindly.

[@TalaTalksNICU]

Thanks so much Tipkamon! If a baby has jaundice secondary to hemolysis, you should see a high reticulocyte count by the time you're worried about the jaundice (i.e. immediately). A premature baby with a hemolytic anemia will still mount a reticulocyte response, although may not be as high. If a baby just has anemia of prematurity though, they are not very good at making new cells. Did this answer your question?

[@TS-kl8zg]

Definitely! Thank you so much again Dr Tala:)

[@katyveader7715]

How about a premature baby , 31 weeks. Mom is O + and baby is O+ Bilirubin at 22 hours of life is 11.5. We increase fluids, start feeds and place under intensive phototherapy. Retic and serial bill follow ups ordered. How fast can we test for g6pd def and what happens if the Bili goes over the lite level? Do we exchange transfuse before having all the answers? I am a nurse and love this channel!

[@TalaTalksNICU]

Hello Katy! So glad you love the channel- thank you!!! So yup- that's super high- but honestly- no matter the cause, the most important aspect would be to bring the bili down- which sounds like is what you're doing. Since both mama and baby are the same blood type - there is less likely for immune hemolysis- but it could still be immune in origin. (e.g. to a Kell antigen or something. A direct coombs would tell you this). And then there's all the other causes- sepsis and DIC and bleeds etc. A high retic will tell you if there is bleeding or hemolysis. otherwise you're getting into weirder territory- metabolic diseases, and disorders of hyperbilirubinemia (Gilbert, criggler-najjar etc). Or G6PD (if it's a boy- and baby is under other stresses too). Also- whenever bill is unexpectedly high- make sure you're getting a direct bili so other causes are not being missed (e.g. TORCH infaction/ liver disease etc). GOOD LUCK!

[@TalaTalksNICU]

Sorry- I didn't answer last question- yes exchange transfusion if needed before any answers (and often we don't have them even when reaching that point). Most important thing is to protect the brain!

[@katyveader7715]

@@TalaTalksNICU Thank you so much for the information! This is such a great resource channel!

[@hossamyasser8651]

Thank you.

[@TalaTalksNICU]

Happy you watched all of these :)

[@hassanfarah9883]

hi dr tala always thank you for your nice presentation, i would like to ask you what is the maximum number that can a total bilirubin reach in newborn i saw bilirubin of 100mg/dl and after repeating it becomes 30mg/dl?

[@TalaTalksNICU]

Wow a 100?!!!! The highest I’ve personally seen is 47- which was nearly all direct. (When I was consulting the hepatologist he told me this was the highest he’d seen too). I don’t think I ever want to see one higher!!!!

[@byebye5907]

Isn't usefull to do the indirect coombs in a blood sample of the mother when we suspect an immun hemolysis going on with a false direct coombs test from the baby? Maybe not because the mother will have physiologically have the antibodies..

[@TalaTalksNICU]

Great point! It depends on the type- generally she may have positive indirect coombs if not ABO- like if to another blood type (Kell etc). Thank you!

[@goecmj]

@@TalaTalksNICU Can you describe when we would do an indirect coombs specifically in the NICU? What additional information does it add that a direct coombs is unable to provide? thank you!!!

[@najiblaroussi1808]

Thank you very much. You are fantastic. Juste about blood types. If the baby have o, the mather can't have AB😊

[@TalaTalksNICU]

Yes- good point. (Although I'll never say never in medicine. Really weird things happen with blood types- where there aren't that many antigens and sometimes mothers aren't always diagnosed as one type! so kind of like a weak A etc.)

[@durgaramasamy5711]

Thank u so much mam❤

[@TalaTalksNICU]

Thank you for being here!

[@محبةالرحمن-م9ح]

Thanks

[@TalaTalksNICU]

Thank you! Glad you're still here :)

[@greensahuaro2834]

Thank you!!!!

[@TalaTalksNICU]

Thank you so much for watching :)

[@greensahuaro2834]

@@TalaTalksNICU thank you so much for teaching and sharing!

[@prakharmathur5174]

Hi madam my daughter is bilirubin suddenly high put in photography down is bilrubin and 3 -4 bilurbin high please suggest the treatment Baby 3 months

[@TalaTalksNICU]

Hello- sorry you're going through this- I can't give any medical advice- but a high bili at this stage is suggestive of a liver / anatomical issue or a viral/ bacterial infection. I'm sure your daughter's medical team is examining these options. Good luck- I hope she is well soon.

[@Amander654]

where is the multiple choice questions

[@TalaTalksNICU]

Hello! Go to Home page or channel and then go to community tab! Bunch of questions there :)

[@gurjarbhai3397]

hello mam,, my child total bilirubin found 22.6 (direct 4.1, indirect 18.5) after 72 hrs of birth having baby weight 3.2 kg,, after giving 15 hra double phototherapy it comes to total bilirubin 13.5,, and again after giving 24 hra single photo and 24 hrs rest it comes to 8.9,, now its all ok ,, or i concern about the first value which founded 22.6. Please share ir experience

[@TalaTalksNICU]

Hello and congratulations on your baby. Obviously I don’t know the details of your case but generally a bili of 22.6 for a short period should not cause lasting damage. The direct bilirubin was elevated - if that is indeed the right number. This should be followed. Good luck