DIAGNOSIS AND TREATMENT of Hyperbilirubinemia. Part 4 - Tala Talks NICU

Direct Coomb positives? High reticulocytes? Immune hemolysis? How to diagnose and treat hyperbilirubinemia. Part four (and final) series- unless you have more questions!
**TIMESTAMPS**
00:40 Recap
01:28 When is a higher bilirubin more concerning
01:51 Nomogram
04:33 Is the infant at a high risk of developing kernicterus
05:05 Blood-brain barrier and free indirect bilirubin
06:13 Determine if hemolytic or non-hemolytic
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Dr. Tala is a board-certified neonatologist, and has worked in busy level III and IV units for the past 15 years. She has won multiple teaching awards throughout her time as a neonatologist.
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References:
Kuzniewicz et al. Predicting the need for phototherapy after discharge. Pediatrics, May 2021.
Bahr et. al. An new hour-specific serum bilirubin normogram for neonates more than 35 weeks of gestation. The journal of pediatrics. 2021 1-6.
Music: www.bensound.com (royalty free with credit)
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*Disclaimer*: This video is intended for educational purposes only and while
we strive to give the most accurate information, errors may occur. Subsequently,
this video should not be a replacement for medical advice.

Пікірлер: 74

  • @bayanalzaher539
    @bayanalzaher5392 жыл бұрын

    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

    @TalaTalksNICU

    2 жыл бұрын

    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

    @anaherpes2501

    2 жыл бұрын

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

  • @abubekerjemal6950
    @abubekerjemal6950 Жыл бұрын

    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

    @TalaTalksNICU

    Жыл бұрын

    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!!

  • @nicurn5030
    @nicurn50302 жыл бұрын

    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

    @TalaTalksNICU

    2 жыл бұрын

    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 :)

  • @fidesminervaballon6028
    @fidesminervaballon60282 жыл бұрын

    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

    @TalaTalksNICU

    2 жыл бұрын

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

  • @erikam5461
    @erikam5461 Жыл бұрын

    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

    @TalaTalksNICU

    Жыл бұрын

    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!

  • @tchiotchoumba9228
    @tchiotchoumba92282 жыл бұрын

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

  • @TalaTalksNICU

    @TalaTalksNICU

    2 жыл бұрын

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

  • @lovescotland7943
    @lovescotland7943 Жыл бұрын

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

  • @TalaTalksNICU

    @TalaTalksNICU

    Жыл бұрын

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

  • @sehrishgul5389
    @sehrishgul53892 жыл бұрын

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

  • @TalaTalksNICU

    @TalaTalksNICU

    2 жыл бұрын

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

  • @anaherpes2501

    @anaherpes2501

    2 жыл бұрын

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

  • @naitramsingh6942
    @naitramsingh69422 жыл бұрын

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

  • @TalaTalksNICU

    @TalaTalksNICU

    2 жыл бұрын

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

  • @rejithamaniyan598
    @rejithamaniyan5987 күн бұрын

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

  • @Kinfe12
    @Kinfe12 Жыл бұрын

    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

    @TalaTalksNICU

    Жыл бұрын

    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 :)

  • @naeemakhtaraneesahmed779
    @naeemakhtaraneesahmed779Ай бұрын

    Very nice and thank you so much

  • @TalaTalksNICU

    @TalaTalksNICU

    Ай бұрын

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

  • @chestermudehwe3755
    @chestermudehwe37555 ай бұрын

    your lectures are clear and very easy to understand

  • @TalaTalksNICU

    @TalaTalksNICU

    5 ай бұрын

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

  • @hossamyasser8651
    @hossamyasser8651 Жыл бұрын

    Thank you.

  • @TalaTalksNICU

    @TalaTalksNICU

    Жыл бұрын

    Happy you watched all of these :)

  • @osamaalagamawy3891
    @osamaalagamawy3891 Жыл бұрын

    ما شاء الله. بارك اللة فيكى

  • @TalaTalksNICU

    @TalaTalksNICU

    Жыл бұрын

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

  • @amirulislam9196
    @amirulislam9196 Жыл бұрын

    excellent

  • @TalaTalksNICU

    @TalaTalksNICU

    Жыл бұрын

    Thanks so much :)

  • @ayesha1708
    @ayesha17082 жыл бұрын

    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

    @TalaTalksNICU

    2 жыл бұрын

    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!!

  • @greensahuaro2834
    @greensahuaro28342 жыл бұрын

    Thank you!!!!

  • @TalaTalksNICU

    @TalaTalksNICU

    Жыл бұрын

    Thank you so much for watching :)

  • @greensahuaro2834

    @greensahuaro2834

    Жыл бұрын

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

  • @donnamiller3687
    @donnamiller36872 жыл бұрын

    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

    @TalaTalksNICU

    2 жыл бұрын

    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
    @stillbreathing1002 жыл бұрын

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

  • @TalaTalksNICU

    @TalaTalksNICU

    2 жыл бұрын

    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.

  • @beverlykwashie1654
    @beverlykwashie16542 жыл бұрын

    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

    @TalaTalksNICU

    2 жыл бұрын

    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?

  • @user-wj8ec7mf1c
    @user-wj8ec7mf1c2 жыл бұрын

    Thanks

  • @TalaTalksNICU

    @TalaTalksNICU

    2 жыл бұрын

    Thank you! Glad you're still here :)

  • @durgaramasamy5711
    @durgaramasamy57115 ай бұрын

    Thank u so much mam❤

  • @TalaTalksNICU

    @TalaTalksNICU

    4 ай бұрын

    Thank you for being here!

  • @mwewachansa9959
    @mwewachansa9959 Жыл бұрын

    wonderful lecture, well explained

  • @TalaTalksNICU

    @TalaTalksNICU

    Жыл бұрын

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

  • @mwewachansa9959

    @mwewachansa9959

    Жыл бұрын

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

  • @TalaTalksNICU

    @TalaTalksNICU

    Жыл бұрын

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

  • @jessicahirschel9300
    @jessicahirschel930011 ай бұрын

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

  • @TalaTalksNICU

    @TalaTalksNICU

    11 ай бұрын

    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!!!

  • @TS-kl8zg
    @TS-kl8zg2 жыл бұрын

    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

    @TalaTalksNICU

    2 жыл бұрын

    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

    @TS-kl8zg

    2 жыл бұрын

    Definitely! Thank you so much again Dr Tala:)

  • @hassanfarah9883
    @hassanfarah9883 Жыл бұрын

    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

    @TalaTalksNICU

    Жыл бұрын

    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!!!!

  • @najiblaroussi1808
    @najiblaroussi18089 ай бұрын

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

  • @TalaTalksNICU

    @TalaTalksNICU

    9 ай бұрын

    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.)

  • @katyveader7715
    @katyveader7715 Жыл бұрын

    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

    @TalaTalksNICU

    Жыл бұрын

    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

    @TalaTalksNICU

    Жыл бұрын

    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

    @katyveader7715

    Жыл бұрын

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

  • @gurjarbhai3397
    @gurjarbhai33972 жыл бұрын

    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

    @TalaTalksNICU

    2 жыл бұрын

    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

  • @byebye5907
    @byebye5907 Жыл бұрын

    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

    @TalaTalksNICU

    Жыл бұрын

    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

    @goecmj

    Жыл бұрын

    @@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!!!

  • @prakharmathur5174
    @prakharmathur51742 ай бұрын

    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

    @TalaTalksNICU

    Ай бұрын

    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
    @Amander654 Жыл бұрын

    where is the multiple choice questions

  • @TalaTalksNICU

    @TalaTalksNICU

    Жыл бұрын

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