Doctor reviews: How to manage HYPERBILIRUBINEMIA!

[@TalaTalksNICU]

*Plug numbers in and get phototherapy etc. threshold here* : bilitool.org To access the article directly, click here: publications.aap.org/pediatrics/article/150/3/e2022058859/188726/Clinical-Practice-Guideline-Revision-Management-of

[@Learnbygiving]

Hi Talah, New Intern here starting on the newborn unit- your video has sincerely improved my quality of life by giving a beautiful walk through of these clinical guidelines in a time efficient manner. Additionally its great to get confirmation from an attending that what I'm comprehending is in line with your interpretation.

[@TalaTalksNICU]

Oh thank you so much- we’re so glad you’re finding them helpful! Hope you’re loving your rotation :)

[@philipthankgod1138]

Although im a medical equipment sales person, i put on my notification so as not to miss any of your video. They are highly enlightening. Thank you Dr.

[@TalaTalksNICU]

What a lovely comment! Impressive you're broadening your knowledge- but also we're so appreciative you're here and watching these videos- and that you subscribed :)

[@amalshehata6375]

Thanks for the precise, precious and clinically accurate Awad updated information

[@TalaTalksNICU]

What a thoughtful comment! Thanks for watching and for taking the time to write!

[@lemmylungu4809]

Watching from Zambia. Very informative and looking forward to more such updates❤

[@TalaTalksNICU]

Hello! So happy you’re watching from Zambia!

[@jeanettlenono5192]

Watching from South Africa

[@blanquitabryant8525]

Excellent presentation !

[@TalaTalksNICU]

Thank you so much!

[@christoph7817]

How do you, in your practice, tell that a newborn has „Hemolysis“? It strikes me as a difficult question, since neither Hemoglobin, LDH nor Haptoglobin seem to be performing well in telling that a baby has hemolysis. When reading the literature, it seems to me that often times a baby with hyperbilirubinema that has a classic constellation of Blood Groups (Mom O, baby something else) and a positive direct Coombs test is simply consideres to having hemolysis. How do you do it? How do you diagnose the newborn with hemolysis?

[@TalaTalksNICU]

Hello! This is a great question! Generally we would suspect hemolysis if the Hct is falling rapidly, the bili is rising quickly (>0.2-0.3 mg/dl/ hr) and there is a high reticulocyte count (>8-10). And bili is staying high despite phototherapy. Sometimes a blood smear can give you a clue too- eg schistocytes in DIC. There can be low key hemolysis with lower numbers though. So you’re right- unless we have a diagnosis- eg spherocytosis or G6PD deficiency etc- we can’t be absolutely sure. Really good point!

[@douyeevinson1547]

Thank you Dr tala! Watching from Nigeria 🇳🇬

[@TalaTalksNICU]

Thank you for being here! Happy you’re watching in Nigeria :)

[@basmadahash1029]

Very helpful! Watching from MI. Can you please talk about some other important AAP recommendations for different neonatal-related topics.

[@TalaTalksNICU]

Hello! First thanks so much for subscribing! I love this idea too- covering big policy statements the AAP came out with. A few more this summer I think :)

[@malikkamuki]

Yes please do similar policy statements 👍👍👍

[@TalaTalksNICU]

Hello! Thank you! We’ll plan on doing more soon- starting with hypothyroidism!

[@NNCCCC63]

Greetings from Timonium (the town , not the radiotracer). Yet another goldmine of information. thank you !

[@TalaTalksNICU]

Ha! Hello!!! Always so happy when you write to us!! Thanks so much again- we value your support!!

[@beverlyreyes7675]

Another good bili tool source to use is the Stanford Bilirecs. It has 2 different tool, one for term and one for preterm .

[@TalaTalksNICU]

Just checked out- so simple and easy to use too. Thanks for the resource. I think we can unclick when doesn't have an NT risk factor too!

[@kennedyadjei-fosu899]

Thank you so much Dr. Tala. Excellent delivery. Watching from Navrongo, Ghana

[@TalaTalksNICU]

Oh thank you so much!!! Already realised I should have included more stuff! How to access the tables and also the follow up published since these guidelines came out!! (I put them in a pinned comment!). But so glad you found it helpful!!

[@ayasakr764]

Great talk as usual, thank U so much Dr Tala , watching from Egypt ❤

[@TalaTalksNICU]

Hello!! Thanks so much for being here and for taking the time to write to us!

[@colamember9048]

Dr. Tala. Thank you for all you do. Perfect video! Very helpful.

[@TalaTalksNICU]

So glad you think so!! Thank you for being here!!

[@colamember9048]

Always looking forward to your videos as a family medicine resident who works with newborns all the time.❤

[@TalaTalksNICU]

Oh that's so great! I love that you're supplementing your education with these videos!!!! Really impressive when you could be watching literally anything else!!!

[@shabirdraayatmalla9]

Thank you Dr.Tala for putting words into action….Excellent….Can you make me wiser about BILITOOL being used for starting PT or escalation of care….Thanks

[@TalaTalksNICU]

Hello! Thanks for writing in! If you go to the bilitool website- it will ask you to plug in the numbers - so GA, bili and how many hours and whether baby has neurotoxic risk factors. Then press submit. And it will tell you the level to get a serum bili (if it was transcutaneous), when to start phototherapy, when to escalate care and when to do an exchange transfusion. It's great!!! does all the work for you!

[@kaetiicat1794]

Could you do a video about use cbc interpretation when looking for signs of infection rather than crp’s? Our docs have been switching over to closer cbc detail rather than crps

[@TalaTalksNICU]

Hello!!! We filmed a couple of videos on CBC when we first started the channel, and then more recently we filmed videos on sepsis. You may find this one helpful: kzbin.info/www/bejne/i5K2c6GLfrikhsU. if you want to check it out? Let us know if there's something else in particular?

[@beverlyreyes7675]

We havent done exchange transfusion for over 15 years in our unit. The IVIG been a good help. Can u explain it more how it works for hyperbili? Mechanism?

[@TalaTalksNICU]

That's great! Well - the way I always thought it worked was that the little antibodies we're giving (in the IVIG) would literally bind with mother's antibodies, so mother's antibodies could not bind to the baby's RBCs. Apparently that's one of the suggested pathways- but it's a lot more complicated than that! May involve activating the complement system and other complications!!! Honestly- it is regularly argued in literature that IVIG may not help that much in ABO incompatibility- but I guess we're all so desperate to avoid exchange transfusions we'll try it. (And I agree- clinically it does seem to have helped us significantly).

[@kebedealemu8859]

thnk you dr tala pediatric resident from Ethiopia ,how can I access this material

[@TalaTalksNICU]

Thank you! Look up at the references- it’s open access so you should be able to see it. And then you can get on bili tool (looked at pinned comment). Good luck!

[@femiearnest7127]

Beautiful and quite illuminative. Well done Dr Tala. Can I get a link to this AAP recommendations? Could checking TCBs in unexposed parts of a baby (like the Anterior Iliac spine covered by diapers) when a baby is already on Phototherapy work? or TCBs are totally inaccurate when Phototherapy has begun. Enjoyed watching this from Nigeria. Good Job Doc!

[@TalaTalksNICU]

Hi! Thanks so much for your lovely comment! And excellent questions! And now I'm thinking of all the things we should have put in the video! Urgh! Will add the link at least to a pinned quote!! The question about checking a TcB under the diaper is excellent. The things is though, generally the highest bilirubin in the skin is usually in the face, and lowers steadily until the feet. (Why babies appear more jaundiced in their face than their belly or legs). So would be more accurate if area is covered- but- by definition would be lower than face anyways! Does that make sense? So happy you're watching from Nigeria!

[@femiearnest7127]

Noted that. Thank you Dr Tala. Can you consider a video on trends in Neonatal resuscitation? Well done.

[@TalaTalksNICU]

@femiearnest7127 YES! We need to cover NRP altogether!

[@drheshamelkordi8529]

Great as usual, my question is if we have baby with TSB in intensive or exchange zone but DSB is so high (20-50%)of total ,shall we go to phototherapy/exchange depending only on TSB? ... Alot of thanks. Dr Hesham ,Egyptian working in KSA

[@TalaTalksNICU]

Hello!! We talk about this all the time!!!! We’re not supposed to subtract the direct bili from total when considering lights etc- but there are risks with double exchanges that should be considered. (And babies go green when they’re put under phototherapy with a high direct bili- normally goes away but doesn’t look great). Usually we’ll make the decision based on just how high the indirect is (and direct) and how sick the baby is- if it’s sepsis or hypotensive then we’re way more likely to escalate care because blood brain barrier is weak. Usually this is a team decision though! Sorry not very helpful - a lot of grayness!

[@Chelsealulu1]

Can you review the recent ACOG statement on resuscitation of 22 weekers? Our neos are concerned that if they do not resuscitate 22 weekers they may face some legal consequences since ACOG now seems to be recommending it? Wonder if we are interpreting it wrong??

[@TalaTalksNICU]

Yes! That sounds like a great idea- thanks for the suggestion! Not sure if was a recommendation but an acceptance of where we are I think- but will try to get to bottom of it properly!!! Thank you

[@marinafrancis314]

What cord Bili level would send a baby to the NICU immediately to start phototherapy?

[@TalaTalksNICU]

The placenta works as a really effective filtration system for bilirubin so it gets rid of the bilirubin before birth- so would be v unlikely that immediately after birth there is an elevated bili. Usually it’s first few hours we note the issue

[@marinafrancis314]

@@TalaTalksNICU hi! Thanks for ur response! For a Coombs positive baby with an elevated cord bili, does that also apply? And would it just be a tcb in the first couple hours of life?

[@khairyelwerfeli]

Thank you so much ❤

[@TalaTalksNICU]

THANK YOU so much! For subscribing and for always being encouraging!

[@ismailabdat6122]

Thanks you

[@TalaTalksNICU]

Thank you for watching and for subscribing!

[@Sensi5455]

I like you presentation it is excellent the other important thing is if the baby is presumed to have a non hemolytic type of hyperbilirubenmia it is good also to consider diagnosis like criggler Najer syndrome as it is also forgotten because of it being rare And considering the exchange transfusion we do see the level of the total serum bilirubin and we also calculate the so called BIND score which helps to assess whether the baby has signs of acute bilirubin encephalopathy thank you

[@TalaTalksNICU]

URGH you're right- I totally should have mentioned the BIND score- and should have at least mentioned the terrifying causes of hyperbili. Every time we put out a video, either I regret stuff we didn't put in or someone lets me know!!! The good thing is we can make more videos- maybe one dedicated to this!! thanks for your suggestions and for taking the time to write them out!!

[@bangaloresatish6600]

Yet again, a comphrensive coverage of the topic. Did you wear yellow dress to match the topic of discussion? I am not sure about the screening for metabolic disorders in US, but I have experienced that the odd ones who had troublesome jaundice later turned out to be Galactosaemia, Hypothyroidism or sepsis. Unfortunately, these screening results were available 3-4 days later. In other words, jaundice or rather jaundice that didn’t behave the typical pattern were the harbingers of more sinister problems. However, these rare conditions, when picked earlier (by sparing a thought during the misbehaving jaundice) would prevent brain damage and are eminently treatable. We could prevent future politicians (brain damage) Unlike, the previous era the emphasis and alert for biliary atresia by watching for pigmented stools, etc has dwindled over the years. Missed Biliary atresia ( before 6 weeks) remains the commonest cause for liver transplantation in this age group. Once again, a great talk. 🫡 As always.

[@TalaTalksNICU]

Such such great points and comments!!!!! Maybe you should be screening out scripts and adding these important points!!! Agree with it all! And totally wore yellow on purpose! Ha! I bought all these scrub tops for filming but imagine wearing yellow at work! Ha!!!! Xx