Podcasts about hyperbilirubinemia

La ictericia neonatal es una condición en la que la piel y los ojos de un recién nacido se tornan de color amarillo. La Academia Americana de Pediatría (AAP) recomienda evaluar los niveles de bilirrubina de un bebé entre 24 y 48 horas después del nacimiento. Es importante conocer los factores de riesgo y las pruebas diagnósticas para la hiperbilirrubinemia y de esto y mucho más, hablamos con nuestro invitado en este episodio de Pediatras en Línea, el Dr. Edson Ruiz. El Dr. Ruiz es médico cirujano egresado de la Universidad Autónoma de Tamaulipas (Matamoros, México). Realizó la especialidad de Pediatría en la Universidad de Texas Tech University Health Science Center El Paso y la subespecialidad en Medicina Neonatal-Perinatal en la Universidad de Tennessee Health Science Center Memphis. Actualmente se desempeña como Profesor Asistente de la Universidad de Tennessee Health Science Center en Memphis, TN con práctica clínica en unidades de cuidados intensivos neonatales de tercer y cuarto nivel. Entre sus intereses clínicos se encuentran las enfermedades hematológicas en los recién nacidos y la reanimación neonatal avanzada en la sala de partos. El Dr. Ruiz está certificado como pediatra por la American Board of Pediatrics y es miembro activo del Tennessee Chapter of the American Academy of Pediatrics y de la American Academy of Pediatrics. En su tiempo libre disfruta de pasar tiempo con su familia y de viajar a ciudades con un importante pasado histórico. Guías para el diagnóstico y manejo de la hiperbilirrubinemia en el recién nacido: Clinical Practice Guideline Revision: Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation . Click or tap if you trust this link." style="color:blue;">Clinical Practice Guideline Revision: Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation | Pediatrics | American Academy of Pediatrics ¿Tienes algún comentario sobre este episodio o sugerencias de temas para un futuro podcast?  Escríbenos a pediatrasenlinea@childrenscolorado.org.

It is not uncommon for newborns to have jaundice. This is due to elevated bilirubin, and may be a normal physiologic phenomenon. But if the bilirubin rises too high or too fast, this may pose a danger for the child. In this episode, we explain why jaundice occurs due to normal newborn bilirubin metabolism, what conditions may lead to increased risk of jaundice, how this is monitored, what are some of the consequences if this is not treated, and of course the common treatments and expected clinical course. So listen up as we shed some light on this subject! This episode written by Drs. Lena van der List and Dean Blumberg. We thank Dr. Christopher Kim, Medical Director Division of Pediatric Primary Care at UC Davis Children’s Hospital, for reviewing this episode, although Drs. Lena and Dean take full responsibility for any errors or misinformation. Additional Resources: Healthy Children Jaundice in Newborns Healthy Children AAP Revises Clinical Guidelines for Hyperbilirubinemia in Newborns Photo courtesy of Positive Parenting It is not uncommon for newborns to have jaundice. This is due to elevated bilirubin, and may be a normal physiologic phenomenon. But if the bilirubin rises too high or too fast, this may pose a danger for the child. In this episode, we explain why jaundice occurs due to normal newborn bilirubin metabolism, what conditions may lead to increased risk of jaundice, how this is monitored, what are some of the consequences if this is not treated, and of course the common treatments and expected clinical course. So listen up as we shed some light on this subject! This episode written by Drs. Lena van der List and Dean Blumberg. We thank Dr. Christopher Kim, Medical Director Division of Pediatric Primary Care at UC Davis Children’s Hospital, for reviewing this episode, although Drs. Lena and Dean take full responsibility for any errors or misinformation. Additional Resources: Healthy Children Jaundice in Newborns Healthy Children AAP Revises Clinical Guidelines f

Send us a textEvaluation of efficacy of oral calcium phosphate as an adjunct to standard-of-care regular phototherapy in cases of neonatal jaundice: a hospital-based double-blind, randomised, placebo-controlled trial.Ghorui A, Chowdhry BK, Manjhi PK, Kumar P, Kumar CM.BMJ Paediatr Open. 2024 Oct 11;8(1):e002902. doi: 10.1136/bmjpo-2024-002902.PMID: 39395818 Free PMC article. Clinical Trial.As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!

Send us a Text Message.Phototherapy Alters the Plasma Metabolite Profile in Infants Born Preterm with Hyperbilirubinemia.Satrom KM, Wang J, Lock EF, Snook K, Lund TC, Rao RB.J Pediatr. 2024 Jun 28:114175. doi: 10.1016/j.jpeds.2024.114175. Online ahead of print.PMID: 38945444As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!

In this episode, we will hear from Cristy Toburen, a nurse practioner who specializes in newborn care. She will be leading a discussion focusing on hyperbilirubinemia, including certain risk factors and new hyperbilirubinemia guidelines.

Authors: Miriam Pettersson and Mats Eriksson

Episode description: The spaced learning series team discusses a case of a patient with hyperbilirubinemia secondary to acute alcoholic hepatitis, who then developed hypoxia and hemolysis. Featuring: Anna Fretz Priyanka Athavale Kirtan Patolia Schemas HyperbilirubinemiaHypoxemiaHemolysis Download CPSolvers App here RLRCPSOLVERS

Link to bioRxiv paper: http://biorxiv.org/cgi/content/short/2023.07.26.550752v1?rss=1 Authors: Guzelkaya, M., Onal, E., Gelinci, E., Kumral, A., Cakan-Akdogan, G. Abstract: Unresolved neonatal hyperbilirubinemia may lead to accumulation of excess bilirubin in the body, and bilirubin in the neural tissues may induce toxicity. Bilirubin induced neurological damage (BIND) can result in acute or chronic bilirubin encephalopathy, causing temporary or lasting neurological dysfunction or severe damage resulting in infant death. Although serum bilirubin levels are used as an indication of severety, known and unknown individual differences affect the severity of the symptoms. The mechanisms of BIND have not been fully understood yet. Here, a zebrafish newborn hyperbilirubinemia model is developed and characterized. Direct exposure to excess bilirubin induced dose and time dependent toxicity linked to the accumulation of bilirubin in the body and brain. Introduced bilirubin was processed by liver which increased the tolerance of larvae. BIND in larvae was demonstrated by morphometric measurements, histopathological analyses and functional tests. The larvae that survived hyperbilirubinemia displayed mild or severe morphologies associated with defects in eye movements, body posture and swimming problems. Interestingly, the plethora of mild to severe clinical symptoms were reproduced in the zebrafish model. Copy rights belong to original authors. Visit the link for more info Podcast created by Paper Player, LLC

As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below.Enjoy!_____________________________________________________________________________________Show notes, articles, and CME form can be found on our website: http://www.the-incubator.org/130/

Live Nursing Review with Regina MSN, RN! Every Monday & Wednesday we are live. LIKE, FOLLOW, & SUB @ReMarNurse for more.     Sign up for the NCLEX 30-Day Challenge Review now at http://www.ReMarNurse.com/30Days   Sign up to RNU - https://remarnurse.com/rnu/   Quick Facts for NCLEX Next Gen Study Guide here - https://bit.ly/QF-NGN Study with Professor Regina MSN, RN every Monday as you prepare for NCLEX Next Gen.   ► Create Free V2 Account - http://www.ReMarNurse.com ► Get Quick Facts Next Gen - https://bit.ly/QF-NGN ► Subscribe Now - http://bit.ly/ReMar-Subscription ► GET THE PODCAST: https://remarnurse.podbean.com/ ► WATCH LESSONS: http://bit.ly/ReMarNCLEXLectures/ ► FOLLOW ReMar on Instagram: https://www.instagram.com/ReMarNurse/ ► LIKE ReMar on Facebook: https://www.facebook.com/ReMarReview/   ReMar Review features weekly NCLEX review questions and lectures from Regina M. Callion MSN, RN. ReMar is the #1 content-based NCLEX review and has helped thousands of repeat testers pass NCLEX with a 99.2% student success rate! ReMar focuses on 100% core nursing content and as a result, has the best review to help nursing students to pass boards - fast!

In this episode, we review the high-yield topic of Hereditary Hyperbilirubinemia ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠from the Gastrointestinal section. Follow ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Medbullets⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ on social media: Facebook: www.facebook.com/medbullets Instagram: www.instagram.com/medbulletsofficial Twitter: www.twitter.com/medbullets

Familiarize learners with the significant changes in the 2022 AAP Hyperbilirubinemia Clinical Practice Guidelines Revision for Newborn Infants Greater than 35 Weeks specifically regarding risk assessment bilirubin monitoring hyperbilirubinemia treatment and post-discharge follow up.

Episode 133: Neonatal JaundiceJennifer explained the pathophysiology of neonatal jaundice and how to treat it and described why screening for hyperbilirubinemia is important.    Written by Jennifer Lai, MS3, College of Osteopathic Medicine of the Pacific Western University of Health Sciences. Comments by Hector Arreaza, MD.  You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.What is neonatal jaundice? Jenni: Infant jaundice, also known as hyperbilirubinemia, is when there is a high level of serum bilirubin causing yellow discoloration of the newborn's skin and eyes. Bilirubin is a red-orange byproduct of hemoglobin catabolism that gives yellow pigment to skin and mucosa membranes. Arreaza: When we see jaundice on the eyes, it is actually the conjunctiva color we are seeing. So, the term “scleral icterus” should be changed to “conjunctival icterus,” but you may get corrected by unaware clinicians. Bilirubin actually binds elastin.What's the pathophysiology/ big picture?Jenni: The key problem is the accumulation of high levels of bilirubin in serum and if left untreated, it can bind to tissues and cause toxicity. There are multiple reasons why there might be too much bilirubin in the serum. Excess bilirubin can be due to a benign normal condition, but it can also be due to a pathologic reason. It is important to differentiate between these two because the management and treatment can differ significantly. Arreaza: Highly bilirubin means that it is being either overproduced or under-eliminated. Physiologic jaundice Most of the time, hyperbilirubinemia is benign and physiologic, with yellowing typically occurring between 2-4 days. Normally, there is a period of transition caused by the turnover of the fetal red blood cells and the immaturity of the newborn's liver to efficiently metabolize bilirubin and increased enterohepatic circulation. The most common reason is that the liver isn't mature enough to get rid of the bilirubin in the bloodstream or because the baby's gut is sterile, so it does not have the bacteria to convert the bilirubin to get it out of the body. In general, newborns have a higher level of total serum or plasma bilirubin levels compared to adults for the following reasons: Newborns have more red blood cells (hematocrit between 50-60), and fetal red blood cells have a shorter life span (85 days vs. 120 days) than those of adults. After birth, there is an increased turnover of fetal red blood cells, so there is more bilirubin.Bilirubin clearance (conjugation and excretion) is decreased in newborns, mainly because of a deficiency of the hepatic enzyme UGT.Increase in the enterohepatic circulation of bilirubin as the amount of unconjugated bilirubin increases due to the limited bacterial conversion of conjugated bilirubin to urobilin.Pathologic JaundicePathologic jaundice includes severe neonatal hyperbilirubinemia, extreme neonatal hyperbilirubinemia, and bilirubin-induced neurologic disorders. We determine the severity of the jaundice using the total serum bilirubin (TSB). It is defined as a TSB >25 (severe) and TSB >30 (extreme). Other concerning signs include a TSB over the 95% percentile, a greater than 5mg/dL/day or 0.2mg/dL/hour, or jaundice that lasts for more than 2-3 weeks. Potential pathologic causes include but are not limited to: Increased bilirubin production from increased hemolysis which is when the red blood cells in the baby are being destroyed faster than normal, this can be due to blood group incompatibilities where the mom's immune system starts to attack the baby's red blood cells (such as Rh incompatibility) or from RBC membrane defects (spherocytosis).Birth Trauma when the head gets bruised after a vacuum or forceps is used to remove the baby from the vaginal canalInfection which prevents the bilirubin from being metabolized and excretedProblems with bilirubin clearance either from enzyme deficiencies such as Crigler-Najjar or Gilbert syndromeObstructed biliary systems causing bile to get stuck in the liverArreaza: Indirect bilirubin is the one elevated in newborns, but if you see direct hyperbilirubinemia, then you have to think of an obstruction.Jenni: Severe hyperbilirubinemia can cause brain damage. The amount of bilirubin and the duration of bilirubin ultimately determine the severity of the brain damage. This is because the bilirubin blocks some mitochondrial enzymes from being able to function properly, also it inhibits DNA synthesis/protein synthesis, and can cause DNA damage. This can ultimately lead to acute bilirubin encephalopathy which is described as 3 different phases: Phase 1 with poor feeding, lethargy, hypotonia, and seizures, Phase 2 with increased tone in extensor muscles causing neck contractions (retrocollis and opisthotonos), and Phase 3 with generalized increased tone. If the bilirubin encephalopathy persists it can also ultimately cause cerebral palsy, sensorineural hearing loss, and gaze abnormalities.  How and when do we treat? No phototherapy:The goal of treating jaundice is to safely decrease the amount of bilirubin in the body. Oftentimes babies with mild hyperbilirubinemia don't get any treatment and we just watch and wait. In premature babies, there is an increased risk for brain toxicity because a lower amount of bilirubin can result in brain toxicity. For these babies, it is important to ensure there is adequate breast milk to both prevent and treat jaundice because it helps the baby get rid of bilirubin through the stool and urine. Arreaza: Indirect sunlight exposure of the baby.Phototherapy:Other babies get phototherapy or more commonly known as light therapy. Phototherapy light treatment is when the baby's skin is exposed to a special blue light which will help break down bilirubin and help with the excretion in stool and urine. The phototherapy should be continuous and placed on as much skin as possible and the treatment should be administered until bilirubin levels drop to a safe level based on the baby's hour-specific thresholds. Arreaza: Home phototherapy is an option (UV blanket) available for rent or purchase.Phototherapy is very safe, however, with any treatment, there are risks and potential side effects. Some of these include skin rashes, loose stools, overheating, and dehydration. Occasionally, babies turn a dark gray-brown color in their skin and urine, but this is temporary and usually resolves on its own. While the baby is receiving phototherapy, it is important to continue breastfeeding to ensure appropriate fluid hydration, but in babies that cannot get enough breast milk, they may need to supplement with formula or even potentially start IV fluids. Benefits of screeningIt is therefore essential for universal bilirubin screening for all newborns prior to discharge to identify newborns who are at risk for developing severe hyperbilirubinemia. Hyperbilirubinemia is extremely common in newborns, with nearly all neonates having a higher total serum bilirubin than adults. The reason we screen is that this reduces the risk of developing severe hyperbilirubinemia and ultimately brain damage. This universal screening also then decreases hospital readmissions for neonatal hyperbilirubinemia. Arreaza: So, we check at 12-24 hours in a typical pediatric unit. We use a bilimeter (transcutaneous) and if we suspect it is not accurate, we do a serum bili. Be aware of the accuracy of bilimeters.How do we screen? We do this prior to newborn discharge through a transcutaneous bilirubin device (TcB) or lab total serum bilirubin (TSB). The bilirubin level is used with the assessment of risk for the development of severe hyperbilirubinemia. Newborn bilirubin screening guidelines include TSB or TcB within 24-48 hours after birth or before discharge. TcB is the noninvasive test, but TSB is the gold standard for assessing neonatal bilirubin. Newborns with visible jaundice in the first 24 hours should be concerned for severe hyperbilirubinemia. These babies should be screened earlier because of the risk of pathologic causes of jaundice. In addition to the bilirubin test, physicians will clinically assess by examining the skin under ambient or daylight to assess whether there is a yellow discoloration of the buccal, gingival, or conjunctival mucosa. Additionally, if a baby presents with scleral icterus, pallor, bruising, hepatosplenomegaly, or cephalohematoma (enclosed hemorrhage), these can be clinical presentations of neonatal jaundice. Follow up:After screening, we recommend that babies be closely monitored if jaundice does occur as it can be well managed with early treatment. A quick way to assess this at home is to press gently on the baby's forehead and if the skin looks yellow where you press, it's probably jaundice. If your baby doesn't have jaundice, then the place where you pressed it should look lighter than normal. _____________________Conclusion: Now we conclude episode number 133, “Neonatal Jaundice.” Jennifer explained the pathophysiology behind the increased levels of bilirubin in babies. She reminded us that it is a physiologic process, but when the level of bilirubin is too high, then we need to start treatment. Treatments include indirect sunlight exposure of the baby, breastfeeding, and in some cases phototherapy, IV fluids, and even antibiotics and exchange transfusion in some cases. Dr. Arreaza reminded us of the importance of screening and monitoring “bili babies” in the clinic. This week we thank Hector Arreaza and Jennifer Lai. Audio editing by Adrianne Silva.Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! ___________________Links:Episode 17: Why does bilirubin deposit in the eyes? – The Curious Clinicians, https://curiousclinicians.com/2021/01/20/episode-17-why-does-bilirubin-deposit-in-the-eyes/.Ansong-Assoku B, Shah SD, Adnan M, et al. Neonatal Jaundice. [Updated 2022 Aug 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532930/.Mayo Clinic. “Infant Jaundice – Symptoms and Causes.” Mayo Clinic, 2018, www.mayoclinic.org/disease-conditions/infant-jaundice/symptoms-causes/syc-20373865.“Newborn Jaundice.” Nhs.uk, 19 Oct. 2017, www.nhs.uk/conditions/jaundice-newborn/#:~:text=Jaundcie%20in%20newborn%20babies%20is.Preud'Homme D., “Neonatal Jaundice.” American College of Gastroenterology, Dec 2012, https://gi.org/topics/neonatal-jaundice/.Wong R., et al. “Risk factors, Clinical Manifestations, and Neurologic Complications of Neonatal Uncomplicated Hyperbilirubinemia.” Up to Date, Last Updated: Jan 5, 2023, https://www.uptodate.com/contents/risk-factors-clinical-manifestations-and-neurologic-complications-of-neonatal-unconjugated-hyperbilirubinemiaRoyalty-free music used for this episode: “Gushito - Burn Flow." Downloaded on October 13, 2022, from https://www.videvo.net/

In this episode of Curbside Consults, we examine the 2022 revision of the clinical practice guideline on the management of hyperbilirubinemia in the newborn infant by the American Academy of Pediatrics (AAP). We are joined by two authors of the revised guideline: Dr. Alex R. Kemper, the Division Chief of Primary Care Pediatrics at Nationwide Children's Hospital and Professor of Pediatrics at The Ohio State University College of Medicine; and Dr. Thomas Newman, Professor Emeritus of Epidemiology & Biostatistics and Pediatrics at UCSF.

Join the conversation about the 2022 AAP Clinical Practice Guideline Revision: Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation with Tim Bahr, MD, FAAP and Host Paul Wirkus, MD, FAAP. In week three the treatment guidelines will be discussed.Submit your questions for Dr. Bahr to questions@vcurb.com. They will be answered in week four. For more information about available credit visit vCurb.com.ACCME Accreditation StatementThis activity has been planned and implemented in accordance with the accreditation requirements and policies of the Colorado Medical Society through the joint providership of Kansas Chapter, American Academy of Pediatrics and Utah Chapter, AAP.  Kansas Chapter, American Academy of Pediatrics is accredited by the Colorado Medical Society to provide continuing medical education for physicians. AMA Credit Designation StatementKansas Chapter, American Academy of Pediatrics designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Updated clinical practice guidelines for management of hyperbilirubinemia – including revised phototherapy thresholds – were published in August, the first major change since 2004. Joanna Parga-Belinkie, MD, attending neonatologist, Division of Neonatology, Children's Hospital of Philadelphia, provides a review for the nursery and primary care clinic, including a new name for “breastfeeding jaundice”; determining risk for isoimmune hemolytic disease; the importance of G6PD in bilirubin results; the limits of visual assessment of jaundice; using transcutaneous bilirubin meters in primary care; answers to parent questions such as, “Will sunlight help jaundiced babies?”; management of “rebound bili”; tools to help measure phototherapy thresholds by age as you adjust to the new guidelines; and more. Published December 2022. This podcast is for general informational and educational purposes only and is not to be considered as medical advice for any particular patient. Clinicians must rely on their own informed clinical judgment in making recommendations to their patients. ©2022 by Children's Hospital of Philadelphia, all rights reserved.

This episode was made in partnership with the Newborn Medicine subcommitee of the American Academy of Pediatrics - Section on Hospital Medicine.    Course: Hyperbilirubinemia in the newborn 35 weeks or more – Updated Guidelines!  Course Director: Tony R Tarchichi MD  - Associate Professor in Dept of Pediatrics at the University of Pittsburgh School of Medicine Course Director: Alison Volpe Holmes, MD, MS, MPH. - Associate Professor of Pediatrics and of the Dartmouth Institute, Geisel School of Medicine at Dartmouth  This Podcast series was created for Pediatric Hospitalists or those healthcare professionals who take care of hospitalized children.  This episode is Hyperbilirubinemia in the newborn 35 weeks or more – Updated Guidelines! As always there is free CME credit of up to 1.25 AMA category 1 for listening to this podcast and going to the Univ of Pitt site. See the link below.  ______________________________________________________ Objectives: Upon completion of this activity, participants will be able to: Review the treatment of hyperbilirubinemia in the newborn 35 weeks or more. Review the definition of Kernicterus. Review the management and when to escalate care in infants more than 35 weeks old who have hyperbilirubinemia. ______________________________________________________ Released:  12/18/2022, Reviewed 12/18/2022, Expire: 12/18/2023 If you are new to the Internet-based Studies in Education and Research (ISER) website (which is how you will get your CME credit), you will first need to create an account: Step 1. Create an Account https://www.hsconnect.pitt.edu/HSC/home/create-account.do If you have used the ISER website in the past, you can click on the link below and then log onto in order to complete the evaluation for this training: Step 2. To access the test for CME credit: https://cme.hs.pitt.edu/ISER/app/learner/loadModule?moduleId=23974&dev=true Accreditation Statement: The University of Pittsburgh School of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. The University of Pittsburgh School of Medicine designates this enduring material for a maximum of  (1.25)  AMA PRA Category 1 CreditsTM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Join the conversation about the 2022 AAP Clinical Practice Guideline Revision: Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation with Tim Bahr, MD, FAAP and Host Paul Wirkus, MD, FAAP. In week two the evidence supporting the 2022 guidelines will be discussed.Submit your questions for Dr. Bahr to questions@vcurb.com. They will be answered in week four. For more information about available credit visit vCurb.com.ACCME Accreditation StatementThis activity has been planned and implemented in accordance with the accreditation requirements and policies of the Colorado Medical Society through the joint providership of Kansas Chapter, American Academy of Pediatrics and Utah Chapter, AAP.  Kansas Chapter, American Academy of Pediatrics is accredited by the Colorado Medical Society to provide continuing medical education for physicians. AMA Credit Designation StatementKansas Chapter, American Academy of Pediatrics designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

This week, Kate, Gary, Henry and Mark discuss a new guideline for managing jaundice in babies, treating painful diabetic peripheral neuropathy, acetazolamide for patients hospitalized with CHF, and screening for CVD in older men.

Join the conversation about the 2022 AAP Clinical Practice Guideline Revision: Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation with Tim Bahr, MD, FAAP and Host Paul Wirkus, MD, FAAP. In week one the differences between the old and new guidelines will be discussed. Submit your questions for Dr. Bahr to questions@vcurb.com. They will be answered in week four. For more information about available credit visit vCurb.com.ACCME Accreditation StatementThis activity has been planned and implemented in accordance with the accreditation requirements and policies of the Colorado Medical Society through the joint providership of Kansas Chapter, American Academy of Pediatrics and Utah Chapter, AAP.  Kansas Chapter, American Academy of Pediatrics is accredited by the Colorado Medical Society to provide continuing medical education for physicians. AMA Credit Designation StatementKansas Chapter, American Academy of Pediatrics designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Recently, the American Academy of Pediatrics (AAP) has revised clinical guidelines on Hyperbilirubinemia and how to treat infants born at least 35. Although it is common for many newborn infants to experience Jaundice, it is important for physicians and primary care providers to understand and monitor newborn babies to ensure they don't develop Hyperbilirubinemia.  In this episode, we are going to discuss what primary care providers should know about these new guidelines and how they are different then the previous guidelines. Today I am happy to be speaking with Dr. Christine Gold.

Does the sight of a jaundiced patient send you into a spiral about what to do next? Indirect, unconjugated, direct, conjugated…what's the difference?! Why do patients with Gilbert's live longer?? Find out in this Kasai-ting discussion of hyperbilirubinemia in the pediatric and adolescent patient. In this second part of our hyperbilirubinemia series, Dr. Niviann Blondet breaks down a stepwise approach for diagnosis, work-up, and management of hyperbilirubinemia.

In this episode of Talking Pediatrics, Dr. Gabi Hester reviews new guidelines recently published by the American Academy of Pediatrics for the diagnosis and management of hyperbilirubinemia in newborns.View the transcript here:https://www.childrensmn.org/for-health-professionals/talking-pediatrics-podcast/talking-pediatrics-guidelines-gabi-code-yellow-new-guidelines-hyperbilirubinemia-9-30-22/

In this episode, we review the high-yield topic of Congenital Hyperbilirubinemia from the Pediatrics section. Follow Medbullets on social media: Facebook: www.facebook.com/medbullets Instagram: www.instagram.com/medbulletsofficial Twitter: www.twitter.com/medbullets

In this special episode Alex R. Kemper, MD, MPH, MS, FAAP, lead author of the clinical practice guideline, Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation, explains the importance of measuring total serum bilirubin in newborns. He tells hosts David Hill, MD, FAAP, and Joanna Parga-Belinkie, MD, FAAP, the 2022 guideline offers clarification on when to start phototherapy and when to give an exchange transfusion. For resources go to aap.org/podcast.

For our 33rd podcast episode, I review the recommendations for screening and managing hyperbilirubinemia. The American Academy of Pediatrics recommends universal screening of bilirubin levels in newborns, so I review how that can be done, when it should occur, and when it should be repeated. We discuss which infants are more at risk for elevated bilirubin levels and how those risk factors contribute to guidelines for the treatment plan. I discuss the nomograms commonly used and recommended by the American Academy of Pediatrics that guide the care of identifying infants at risk as well as when they should be treated. I review phototherapy, the primary treatment plan for hyperbilirubinemia, including how it effectively lowers bilirubin levels as well as the clinical considerations that should be applied during treatment. Whether you are a neonatal clinician or a parent, this review on how to effectively screen for and manage hyperbilirubinemia will be beneficial. Hyperbilirubinemia is incredibly common in neonates. Clinicians who care for infants whether they are a term newborn in the nursery or an infant in the NICU, will manage infants with elevated bilirubin levels. And parents of either term, healthy infants, or those critically ill in the NICU, it is essential that you understand the risks of hyperbilirubinemia and the screening and management process for it. Tune in now to learn more!Our NICU Roadmap: A Comprehensive NICU Journal: https://empoweringnicuparents.com/nicujournal/NeoTech NeoShades Free Sample: neotechneoshades.comNICU Mama Hats: https://empoweringnicuparents.com/hats/NICU Milestone Cards: https://empoweringnicuparents.com/nicuproducts/Bilirubin Document: https://empoweringnicuparents.com/bili/Empowering NICU Parents Show Notes: https://empoweringnicuparents.com/episode33Empowering NICU Parents Instagram: https://www.instagram.com/empoweringnicuparents/Empowering NICU Parents FB Group: https://www.facebook.com/groups/empoweringnicuparentsPinterest Page: https://pin.it/36MJjmH

Rebecca and Darla discuss Neonatal Hyperbilirubinemia, also referred to as jaundice. 

Rebecca and Darla discuss Neonatal Hyperbilirubinemia, also referred to as jaundice. 

Rebecca and Darla discuss Neonatal Hyperbilirubinemia, also referred to as jaundice. 

Rebecca and Darla discuss Neonatal Hyperbilirubinemia, also referred to as jaundice. 

It is likely that you have heard the terms jaundiced and/or bilirubin. And although it is very common for infants to develop elevated bilirubin levels otherwise known as hyperbilirubinemia, do you actually know or understand why? As a NICU provider, I think it is essential that parents know the condition their infant is facing, but it is also important to understand the why behind its occurrence. If you do not understand the why, the treatment plan will also not make very much sense to you. I believe parents should be actively involved and partners in their baby's care. But, it is nearly impossible to be actively engaged in the decision-making process if you do not understand the why behind the condition.  For our 32nd podcast episode, I break down how our bodies process bilirubin, how we eliminate it, what causes the skin color to become jaundiced, why we as neonatal clinicians monitor bilirubin levels so closely, and I also review some of the common conditions that increase your infant's risk of developing hyperbilirubinemia. Some of the pathophysiology of hyperbilirubinemia can be confusing, but I review it in a way that will make sense to you so you can learn why elevated bilirubin levels occur, and even more importantly, understand your baby's treatment plan. The review will also be very beneficial for novice NICU clinicians or those that need a refresher on the pathophysiology of hyperbilirubinemia in term and preterm infants. So let's get to it!Our NICU Roadmap: A Comprehensive NICU Journal: https://empoweringnicuparents.com/nicujournal/NeoTech NeoShades Free Sample: neotechneoshades.comNICU Mama Hats: https://empoweringnicuparents.com/hats/Empowering NICU Parents Show Notes: https://empoweringnicuparents.com/episode31Empowering NICU Parents Instagram: https://www.instagram.com/empoweringnicuparents/Empowering NICU Parents FB Group: https://www.facebook.com/groups/empoweringnicuparentsPinterest Page: https://pin.it/36MJjmH

Some new-born babies will suffer from jaundice and there are several Cochrane reviews of possible ways to prevent or treat it. These were added to in July 2021 with a new review of the effects of sunlight. We asked the review's lead author, Delia Horn from the Larner College of Medicine at the University of Vermont in the USA, to tell us about the importance of this topic and the findings of the review.

Some new-born babies will suffer from jaundice and there are several Cochrane reviews of possible ways to prevent or treat it. These were added to in July 2021 with a new review of the effects of sunlight. We asked the review's lead author, Delia Horn from the Larner College of Medicine at the University of Vermont in the USA, to tell us about the importance of this topic and the findings of the review.

Aren't all babies a little jaundiced anyways? What's up with those phototherapy lights? Come for the answers, stay for this de-light of a conversation with pediatrician Dr. Alison Holmes and neonatologist Dr. Tom Shimotake, both of whom have extensive experience with guiding commonly used guidelines for neonatal hyperbilirubinemia. We will cover common and rarer etiologies of neonatal hyperbilirubinemia, the whens and hows of working up and screening, and the ins and outs of treatment.

What does IDM stand for? In the medical world, IDM is an acronym for Infant of Diabetic Mother. In this episode, we review the common complications associated with Infants of Diabetic Mothers. You may be surprised to hear that there are several complications beyond hypoglycemia or low blood sugars including but not limited to macrosomia, asphyxia, small for gestational age, respiratory distress, cardiac anomalies, neurological impairments, polycythemia, hyperbilirubinemia, hypocalcemia, and hypomagnesemia. Plus IDM infants are also at an increased risk for a preterm delivery and/or a cesarean section delivery due to their risk of complications later during the pregnancy or potentially larger size. Not only will we break down the potential complications the IDM infant is at risk for one-by-one, but we also discuss the pathophysiology behind each diagnosis as well as the typical treatment plan for each complication. If you are currently pregnant and have been diagnosed with gestational diabetes or had pre existing diabetes, this episode is for you! Or if you just had your baby and had diabetes with the pregnancy, this episode will provide you some great education. Empowering NICU Parents Show Notes: https://empoweringnicuparents.com/episode19/Empowering NICU Parents Instagram: https://www.instagram.com/empoweringnicuparents/Empowering NICU Parents FB Group:https://www.facebook.com/groups/empoweringnicuparentsWebsite Link: https://empoweringnicuparents.com/episode19/

A1C is an easy way to diagnose and monitor diabetes, use and limitations of A1C are discussed with Dr Rodriguez. Vaginal metformin is mentioned as an anecdote which has not been proven to work we remembered Memorial Day. Introduction: Vaginal Metformin.  By Hasaney Sin, MD, and Hector Arreaza, MD.Today is May 31, 2021.  There’s a saying that I came across on social media that has always spoken to me which I find relevant to our vocation. “The more I learn, the more I find out I don’t know”. So comes the joys (and challenges) of our chosen career. Case in point, have you ever heard of vaginal metformin? Neither have I, until today. There was a randomized clinical trial plan in 2013 at Assuit University in Egypt studying the effectiveness of vaginal metformin for the treatment of polycystic ovarian syndrome (PCOS). As primary care providers, we are very aware of the gastrointestinal side effects of metformin when taken PO. This sometimes prevents compliance with metformin. The study at Assuit University was to study the effectiveness of metformin when given vaginally in the effectiveness of treating PCOS, while also decreasing the undesirable side effects of metformin when given PO in hopes of also ultimately improving adherence. Unfortunately, the study was planned to be finished in 2014, but no results have been published thus far[1]. Stay tuned in case there is any update.Arreaza: I had to do a search because I was very curious too. There is at least one occurrence when vaginal metformin was mentioned, at least in English. It was in an online forum where a doctor recommended vaginal metformin for PCOS to a patient. This has not been evaluated or approved by any organization, so I would not recommend it. You know what would be great? Metformin patches! There you have a business idea guys: The Metfo-patch®. This is Rio Bravo qWeek, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California. Our program is affiliated with UCLA, and it’s sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. Introduction: Memorial Day. Written by Valerie Civelli, MD, read by Steven Saito, MD, and Hector Arreaza, MDWhat is Memorial Day? Memorial Day is an American holiday at the end of May to honor the men and women who died while serving in the US military. It has great historical meaning to Americans. It originated from the Civil War which claimed more lives than any other conflict in US history. Civil war ended in 1865.   A fun fact to know, is that Memorial Day, was originally called “Decoration Day”.  It was 3-years after the Civil war ended, May 5, 1868, that “Decoration Day” was declared as a time for the nation to decorate the graves of those lost in war.  Graves were adorned with flowers and their lives celebrated.  Maj. Gen. John A. Logan then declared that “Decoration Day” should be observed on May 30th. It is believed that this date was chosen because flowers would be in full bloom across the country. The “birthplace” of “Memorial Day” was recognized as coming from Waterloo, New York, because Waterloo was the first to use this term to expand honor and recognition of all US fallen soldiers of war from the Civil War and from World War I. In 1971, “Memorial Day” was officially declared a national federal holiday: The National Moment of Remembrance encourages all Americans to pause wherever they are at 3:00 p.m. local time on Memorial Day for a minute of silence, to remember and honor those who have died in service to the nation. If you value your freedom wherever you are, this Memorial Day at 3:00 p.m., pause for a minute to recognize all of our military men and women, both past and present who served and continue to serve our country. We honor every soldier who lost his or her life in any war against America. You are the reason for our freedoms.  You gave the ultimate sacrifice, and we do not take this for granted. To all military members who have died at war, we appreciate the privileges we have today because of you. We honor the costly price at which it came.  We remember you. We honor you. We sincerely thank you. Happy Memorial Day everyone! ___________________________A1C.By Hector Arreaza, MD, and Yodaisy Rodriguez, MD.   Definition. Glycated hemoglobin (glycohemoglobin, hemoglobin A1c, or just A1c) is a form of hemoglobin that is chemically linked to a sugar. Glucose spontaneously bind with hemoglobin, when present in the bloodstream of humans.A1C refers to the percentage of glycosylation of the hemoglobin A1C chain and correlates with the average blood glucose levels over the previous 2-3 months from the slow turnover of red blood cells in the body. A RBC lives 120 days.History of A1C. Huisman and Meyering separated glycohemglobin for the first time in 1958. A1c for monitoring the degree of control of glucose metabolism in diabetic patients was proposed in 1976 by Anthony Cerami, Ronald Koenig and coworkers.A1C was first included in the ADA guidelines as a diagnostic test for diabetes in 2010. Prior to that random glucose or fasting plasma glucose were used for diagnosis.For diagnosis of diabetes, A1C testing should be done by a technique certified by the National Glycohemoglobin Standardization Program and consistent with the Diabetes Control and Complications Trial reference assay.A1C levels. A1C 6.5% is diabetes.Of note, other criteria for diagnosing diabetes: Fasting plasma glucose >126 mg/dL, 2-hour plasma glucose > 200, random glucose >200 plus classic symptoms.In patients with prediabetes, A1C should be tested yearly.The American Diabetes Association (ADA) has recommended glycated hemoglobin testing (HbA1c) twice a year for patients with stable glycemia, and quarterly for patients with poor glucose control. Use ADA guidelines to assess targets.Point-of-care A1C (POC A1C): POC is not recommended for screening or diagnosis but it is good for monitoring.A1C limitations.There are some limitations to A1C testing, and an incomplete correlation between A1C level and average glucose level in certain individuals.Nonglycemic Factors That May Interfere with A1C MeasurementFalsely lower A1C: Acute blood loss, Chronic liver disease, Hemolytic anemias, Patients receiving antiretroviral treatment for human immunodeficiency virus, Pregnancy, Vitamins E and C. Patients being treated for iron, B12 or folate deficiency, EPO, chronic hemolysis (thalassemia). Lower or elevate A1C: Hemoglobinopathies or hemoglobin variants, Malnutrition Falsely elevate A1C: Aplastic anemias, Hyperbilirubinemia, Hypertriglyceridemia, Iron deficiency anemias, Renal failure, Splenectomy.For example, when RBCs have a short life, like in acute bleeding, the A1C is falsely low. On the other hand, when RBCs live longer (history of splenectomy and aplastic anemias) the A1C is falsely elevated. It’s a good idea to do CBC with A1C.Ethnic groups: Hemoglobinopathies or hemoglobin variants can change A1C levels and may be more prevalent among certain racial and ethnic groups. A1C tends to be higher in some races/ethnic groups: AA, Hispanic-Americans, Asian-Americans.Other A1C limitations: It gives you an average, patient may be experiencing hypoglycemia alternated with hyperglycemia and result in normal A1C. Screening for diabetes.ADA: Screen for diabetes or prediabetes all asymptomatic adults, according to the ADA, who have overweight or obesity with one or more risk factor (first degree relative with diabetes, high risk race or ethnic group, history of CVD, hypertension, dyslipidemia, PCOS, physical inactivity, severe obesity, acanthosis nigricans), patients with prediabetes (every year), women with GDM (every 3 years), all other patients after 45 years of age. If results are normal, test every 3 years, patients with HIV.USPSTF: Adults aged 40 to 70 years who are overweight or obese. The USPSTF recommends screening for abnormal blood glucose as part of cardiovascular risk assessment in adults aged 40 to 70 years who are overweight or obese. (Draft: Asymptomatic adults ages 35 to 70 years who are overweight or obese) This is a Grade B recommendation. Clinicians should offer or refer patients with abnormal blood glucose to intensive behavioral counseling interventions to promote a healthful diet and physical activity. The USPSTF recommends screening for gestational diabetes mellitus (GDM) in asymptomatic pregnant women after 24 weeks of gestation. This is a Grade B recommendation.Grade I recommendation (insufficient evidence): Asymptomatic pregnant women, Before 24 Weeks of Gestation. The USPSTF concludes that the current evidence is insufficient to screen for GDM in asymptomatic pregnant women before 24 weeks of gestation.A1C Targets.A1C goals can range from 6.5% to 8%. Target is individualized based on life expectancy, disease duration, presence of complications, CVD risk factors, comorbid conditions and risks for severe hypoglycemia. Sometimes your goal can be independent of A1C, for example, your goal can be to avoid complications. As a fun fact, A1C is not used in veterinary medicine.Conclusion.By Hector Arreaza, MD. Now we conclude our episode number 54 “A1C”, three characters that may not mean much for most people but for patients with diabetes, it is a very important number to remember. Remember to check the A1C in all your patients with poor control of diabetes every 3 months, or every 6 months in patients with good control. A1C has its limitations but it certainly is the best way to assess your patients’ glycemic control. We started this episode by giving you a random report about vaginal metformin, the study was unfinished, and we also reminded you of the importance of remembering our heroes during Memorial Day. Even without trying, every night you go to bed being a little wiser.Thanks for listening to Rio Bravo qWeek. If you have any feedback about this podcast, contact us by email RBresidency@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. This podcast was created with educational purposes only. Visit your primary care physician for additional medical advice. This week we thank Hector Arreaza, Hasaney Sin, Valerie Civelli, Yodaisy Rodriguez, and Steven Saito. Audio edition: Suraj Amrutia. See you next week!References:Vaginal Administration of Metformin in PCOS Patients, U.S. National Library of Medicine, Clinical Trials.Gov, https://clinicaltrials.gov/ct2/show/study/NCT02026869. Office of Public and Intergovernmental Affairs, U.S. Department of Veteran Affairs,  https://www.va.gov/opa/speceven/memday/history.asp, accessed on May 26, 2021.  Pippitt K, Li M, Gurgle HE. Diabetes Mellitus: Screening and Diagnosis. Am Fam Physician. 2016 Jan 15;93(2):103-9. Erratum in: Am Fam Physician. 2016 Oct 1;94(7):533. PMID: 26926406. https://www.aafp.org/afp/2016/0115/p103.html. Standards of Medical Care in Diabetes – 2021, Diabetes Care, January 1, 2021, vol 44 issue supplement 1, https://care.diabetesjournals.org/content/diacare/suppl/2020/12/09/44.Supplement_1.DC1/DC_44_S1_final_copyright_stamped.pdf.

Today we'll be covering Direct Hyperbilirubinemia, going along with this month's theme, Newborn Medicine. If you haven't listened to our podcast before, each week we have a case-based discussion about a medical topic to help you study for the pediatric medicine board exam. Episodes are released every weekend, and the case is then reviewed and reinforced on social media throughout the week.   Follow the podcast on social media: Facebook- @portablepeds (www.facebook.com/portablepeds) Twitter- @portablepeds (www.twitter.com/portablepeds)   We'd love to hear from you via email at portablepeds@gmail.com!   Also, feel free to visit our website, www.portablepeds.com, for more content.   Today's Case:   A four week old infant is brought into your primary care office.  She was born at 39w6d via uncomplicated home delivery and missed her newborn appointment.  Mom received appropriate prenatal care, and the pregnancy was uncomplicated.  The child's birth weight was appropriate for age.  She has been breast feeding well and has continued to gain weight along the 30th percentile.  She has had no fevers or other signs of illness. On exam the child is markedly jaundiced with prominent icteric sclera.  You note that she has a firm, palpable liver edge.  She has no dysmorphic features or murmurs on exam.  She has a stool in the office which is a pasty white color.  You check a total serum bilirubin which is notable for direct hyperbilirubinemia.  You also obtain an abdominal ultrasound, which is notable for a triangular fibrous mass at the porta hepatis.  What is the most likely diagnosis?     Choledochal cyst  Physiologic jaundice Alagille syndrome Biliary atresia Galactosemia   We would like to give an enormous thank you to Zack Goldmann for designing this podcast's logo and accompanying artwork. You can find more of his work at www.zackgoldmann.com.   The intro and outro of this podcast is a public domain song obtained from scottholmesmusic.com.   Intro/Outro- Hotshot by Scott Holmes   Disclaimer: This podcast is intended for healthcare professionals. The information presented is for general educational purposes only and should NOT be used as professional medical advice or for the diagnosis or treatment of medical conditions.   The views and opinions expressed do not represent the views and opinions of our employer or any affiliated institution. Expressed opinions are based on specific facts, under certain conditions, and subject to certain assumptions and should not be used or relied upon for any other purpose, including, but not limited to, the diagnosis or treatment of medical conditions or in any legal proceeding. Full terms and conditions can be found at portablepeds.com.   Thanks for listening! As always, please Rate and Review this podcast on Apple Podcasts, Facebook, or your favorite podcasting platform. Also, Subscribe to get all the latest episodes, and Share this episode with someone you think would enjoy it! Hope to see you real soon!

Today we'll be covering Indirect Hyperbilirubinemia, going along with this month's theme, Newborn Medicine. If you haven't listened to our podcast before, each week we have a case-based discussion about a medical topic to help you study for the pediatric medicine board exam. Episodes are released every weekend, and the case is then reviewed and reinforced on social media throughout the week.   Follow the podcast on social media: Facebook- @portablepeds (www.facebook.com/portablepeds) Twitter- @portablepeds (www.twitter.com/portablepeds)   We'd love to hear from you via email at portablepeds@gmail.com!   Also, feel free to visit our website, www.portablepeds.com, for more content.   Today's Case:   A child presents to your primary care clinic, who is a three-day old exclusively breast-fed female of European descent born at 36 weeks gestation.  Pregnancy, labor, delivery, and post-natal course were uncomplicated.  Mom's blood type was A+, and this is her first child.  The infant was discharged at 24 hours of life, and her bilirubin level at that time was 6mg/dL, all indirect, which corresponded to a low intermediate risk level for developing severe hyperbilirubinemia.  She appears jaundiced on exam, and you note that she has lost approximately 8% of her birth weight.  Her current total serum bilirubin is 12mg/dL, all indirect.  You continue to trend bilirubin levels in your office throughout the week.  Her total bilirubin level peaks on day of life four and is down-trending by day of life six. What is the most likely etiology of her jaundice?   Breast milk jaundice Breastfeeding jaundice ABO incompatibility Biliary atresia G6PD deficiency   We would like to give an enormous thank you to Zack Goldmann for designing this podcast's logo and accompanying artwork. You can find more of his work at www.zackgoldmann.com.   The intro and outro of this podcast is a public domain song obtained from scottholmesmusic.com.   Intro/Outro- Hotshot by Scott Holmes   Disclaimer: This podcast is intended for healthcare professionals. The information presented is for general educational purposes only and should NOT be used as professional medical advice or for the diagnosis or treatment of medical conditions.   The views and opinions expressed do not represent the views and opinions of our employer or any affiliated institution. Expressed opinions are based on specific facts, under certain conditions, and subject to certain assumptions and should not be used or relied upon for any other purpose, including, but not limited to, the diagnosis or treatment of medical conditions or in any legal proceeding. Full terms and conditions can be found at portablepeds.com.   Thanks for listening! As always, please Rate and Review this podcast on Apple Podcasts, Facebook, or your favorite podcasting platform. Also, Subscribe to get all the latest episodes, and Share this episode with someone you think would enjoy it! Hope to see you real soon!

We review the history and pathophysiology of neonatal jaundice. We are joined by Jessica Morse, MD, Assistant Professor of Neonatal-Perinatal Medicine at the University of Texas Southwestern Medical Center, and Medical Director of the Parkland Memorial Hospital Newborn Nursery.

We discuss the clinical approach to evaluation and management of neonatal jaundice. We are joined by Jessica Morse, MD, Assistant Professor of Neonatal-Perinatal Medicine at the University of Texas Southwestern Medical Center, and Medical Director of the Parkland Memorial Hospital Newborn Nursery.

In this chapter of the Rwandan National Neonatal Protocol, Dr. Hippolyte Bwiza-Muhire discusses risk factors for hyperbilirubinemia in full term and premature infants, how to assess hyperbilirubinemia on a physical exam and how to initiate laboratory testing to determine, initiate, and manage appropriate treatment for hyperbilirubinemia in the neonate. Initial publication: February 12, 2020. Please visit: www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open access-and thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu

Almost 10% of newborn infants develop significant hyperbilirubinemia, and many require phototherapy treatment. This is costly and can increase the likelihood of patients developing allergic diseases. However the costs of not treating neonatal jaundice can be more severe as it can cause lifelong disability. Precise patient monitoring and deliberate treatment assignment are therefore essential for at-risk neonates. In this episode, we meet Sven Wellman, then of the University of Basel's Children Hospital in Switzerland. He and his team developed an online tool that uses machine learning methods to accurately predict neonates at risk of developing clinically relevant hyperbilirubinemia. See acast.com/privacy for privacy and opt-out information.

Liza Green Golan Mackintosh MD, and Solomon Behar, MD discuss the nuances of managing neonatal hyperbilirubinemia with pediatric superstar/doctor/researcher Vinod Bhutani. Yes, that Dr. Bhutani. To hear Part Two of this interview. Subscribe today at https://www.hippoed.com/peds/rap/

Ryoichi FUJIWARA, Dr. Margarete Fischer-Bosch - Institut für Klinische Pharmakologie, Tubingen University, Stuttgart, GERMANY speaks on “Successful treatment of Crigler-Najjar syndrome model mice with zinc protoporphyrin: Understanding the beneficial effects of hyperbilirubinemia”. This seminar has been recorded by ICGEB Trieste.

This podcast reviews the definition, pathophysiology, and common etiologies of conjugated hyperbilirubinemia. Listeners will also learn approach to the diagnosis and management of conjugated hyperbilirubinemia, with a focus on biliary atresia. The episode was written by Jennifer Ng with the help of Dr. Jason Silverman. Jennifer is a senior medical student at the University of Alberta and Dr. Silverman is pediatric gastroenterologist and assistant professor at the University of Alberta and the Stollery Children’s Hospital in Edmonton.

Most newborns will have some jaundice.  Most jaundice is benign. So, how can we sort through the various presentations and keep our newborns safe? Pathologic Jaundice When a baby is born with jaundice, it’s always bad.  This is pathologic jaundice, and it’s almost always caught before the baby goes home.  Think about ABO-incompatbility, G6PD deficiency, Crigler-Najjar, metabolic disturbances, and infections to name a few.  Newborns are typically screened and managed. Physiologic Jaundice Physiologic jaundice, on the other hand, is usually fine, until it’s not. All babies have some inclination to develop jaundice.  Their livers are immature.  They may get a little dehydrated, especially if mother’s milk is late to come in.  In today’s practice, we are challenged to catch those at risk for developing complications from rising bilirubin levels. Hyperbilirubinemia is the result of at least one of three processes: you make too much, you don’t process it enough, or you don’t get rid of it fast enough. Increased production Bilirubin mostly comes from the recycling of red blood cells. Heme is broken down in in the liver and spleen to biliverdin then bilirubin. Normal, full term babies without jaundice run a little high -- bilirubin production is two to three times higher than in adults, because they are born with a higher hematocrit.  Also, fetal hemoglobin is great at holding on to oxygen, but has a shorter life span, and high turn-over rate, producing more bilirubin. Impaired conjugation Think of bilirubin as your email.  Unconjugated bilirubin is your unread email.  To process it or get rid of it – you have to open it.  Of course, the more unread messages that accumulate, the more unwell you feel. Conjugated bilirubin is your opened and processed email.  So much easier to sort out, deal with, and get rid of. Decreased excretion Both unread email and unconjugated bilirubin continue to float around in your inbox.  Unconjugated bilirubin keeps getting reabsorbed in the intestinal mucosa through enterohepatic circulation. Processed email and conjugated bilirubin are easier to sort out.  Conjugated bilirubin is water soluble, so it goes right into the read folder in your gallbladder, and is excreted off your inbox.  Later on down the line in the intestine, conjugated bilirubin can’t be reabsorbed through the intestinal mucosa.  Like when you open an email and forget about it – it passes on through, out of your system. Newborns are terrible at answering emails.  There is a lot of unread unconjugated bilirubin is floating around.  The liver and spleen are just not able to keep up. Also, newborns have a double-whammy administrative load.  Normally, bacteria in the gut can further break down conjugated bilirubin to urobilin and get excreted in the urine.  The infant’s gut is relatively sterile, so no admin assistance there.  Just to add to the workload a poor little newborn has to do – he is being sabotaged by extra beta-glucuronidase which will take his hard-earned conjugated bilirubin and unconjugate it again, then recycle it, just like email you “mark as unread”. How Does this All Go Down? The recommended followup is 48 hours after discharge from the nursery for a routine bilirubin check, often in clinic, and often via the transcutaneous route. More Specifically: Infant Discharged Should Be Seen by Age Before age 24 h 72 h Between 24 and 48 h 96 h Between 48 and 72 h 120 h The neonate will end up in your ED off hours, if there is concern, if his status deteriorates, or simply by chance.  We need to know how to manage this presentation, because time is of the essence to avoid complications if hyperbilirubinemia is present. Critical Action #1: Assess risk for developing severe hyperbilirubinemia. This will tell you: check now in ED or defer to clinic (default is to check). Risk Factors for Developing Hyperbilirubinemia Total serum bilirubin/Transcutaneous bilirubin in high-risk zone Jaundice in first 24 hours ABO incompatibility with positive direct Coombs, known hemolytic disease, or elevated ETCO Gestational age 35-36 weeks Prior sibling had phototherapy Cephalohematoma or bruising Exclusive breastfeeding, especially with poor feeding or weight loss East Asian Race Critical Action #2 Check bilirubin and match this with how old the child is -- in hours of life -- at the time of bilirubin measurement. This will tell you: home or admission. Use the Bilitool or Bhutani Nomogram (below).   Can I go Home Now? Risk Stratification for Developing Severe Hyperbilirubinemia. Bhutani et al. Pediatrics. 1999. In general, babies at low-risk and low-intermediate risk can go home (see below).  Babies at high-intermediate or high risk are admitted (see below). Critical Action #3: Assess risk for developing subsequent neurotoxicity. This will tell you: a) phototherapy or b) exchange transfusion     Phototherapy Now?     Exchange Transfusion Now? Threshold for Initiating Exchange Transfusion by Risk Stratum. Bhutani et al. Pediatrics. 1999. Home care The neonate who is safe to go home is well appearing, and not dehydrated.  His total bilirubin is in the low to low-intermediate risk for developing severe hyperbilirubinemia, and he is not at high risk for neurotoxicity based on risk factors. Babies need to stay hydrated.  Breast feeding mothers need encouragement and need to offer feeds 8-12 times/day – an exhausting regimen.  The main message is: stick with it.  Make sure to enlist the family's help and support to keep Mom hydrated, eating well, and resting whenever she can.  Supplementing with formula or expressed breast milk is not routinely needed.  Be explicit that the neonate should not receive water or sugar water – it can cause dangerous hyponatremia.  A moment of solid precautionary advice could avert a disaster in the making. The child’s pediatrician will help more with this, and you can remind nursing mothers of the excellent La Leche League – an international group for breastfeeding support.  They have local groups everywhere, including a hotline to call. Nursery Care If the baby is at high intermediate or high risk for hyperbilirubinemia, then he should be admitted for hydration, often IV.  Most babies with hyperbilirubinemia are dehydrated, which just exacerbates the problem. Bililights or biliblankets, provide the baby with the right blue spectrum of light to isomerize bilirubin to the more soluble form.  Traditionally, we have thought them to be more effective or safer than filtered sunlight.  A recent randomized control trial by Slusher et al. in the New England Journal of Medicine compared filtered sunlight versus conventional phototherapy for safety and efficacy in a resource-poor environment.  These were all term babies with clinically significant jaundice in Nigeria.  To standardize the intervention, they used commercial phototherapy canopies that remove most UV rays. None of them became dehydrated or became sunburned.  The filtered sunlight resulted in a 93% successful treatment versus 90% for conventional phototherapy.  My take away: we now have some evidence basis for using filtered sunlight as an adjunct for babies well enough to go home. Critical Care Although rare, the critically ill neonate with hyperbilirubinemia requires immediate intervention. He will be dehydrated – possibly in shock.  He will be irritable. Or, he may just have a dangerously high bilirubin level – at any minute he could develop bilirubin induced neurologic dysfunction, or BIND, especially when bilirubin concentrations reach or surpass 25 mg/dL (428 micromol/L).  The bilirubin is so concentrated that it leeches past the blood brain barrier and causes neuronal apoptosis.  BIND is a spectrum from acute bilirubin encephalopathy to kernicterus, all involving some disorder in vision, hearing, and later gait, speech, and cognition. Acute bilirubin encephalopathy starts subtly.  The neonate may be sleepy but hypotonic or have a high-pitched cry; he maybe irritable or inconsolable, jittery or lethergic. The dehydration and neurologic dysfnction from the hyperbilirubinemia may even cause fever.  Check the bilirubin in any neonate you are working up for sepsis. Acute bilirubin encephalopathy may progress to an abnormal neurologic exam, seizures, apnea, or coma. Kernicterus is the final, permanent result of bilirubin encephalpathy.  The child may have choreoathetoid cerebral palsy with chorea, tremor, ballismus, and dystonia.  He may have sensorineural hearting loss, or cognitive dysfunction. It is for this reason that any child sick enough to be admitted should be considered for exchange transfusion.  Most babies need just a little gentle rehydration and bililights, but to be sure, the admitting team will look at a separate nomogram to gage the child’s risk and decide whether to pull the trigger on exchange transfusion.  For our purposes, a ballpark estimate is that if the total serum bilirubin is 5 mg/dL above the phototherapy threshold, or if they have any red flag signs or symptoms, then exchange transfusion should be started. Exchange transfusion involves taking small aliquots of blood from the baby and replacing them with donor blood.  It’s often a manual procedure, done with careful monitoring.  It can be done with any combination of umbilical arteries or veins with peripheral arteries or veins.  In general, arteries are the output, veins are for transfusion. The baby may need a double-volume exchange, which ends up replacing about 85% of circulating blood, a single-voume exchange, replacing about 60% of blood, or any fraction of that with apartial volume exchange.  It is a very delicate procedure that requires multiple hours and often multiple staff. For our pruposes, just be aware that the jaundiced baby in front of you may need escalation of his care. Summary Find out the hour of life of the baby at the time of bilirubin measurement.  Identify risk factors for developing severe hyperbilirubinemia and/or neurotoxicity The child with low to low-intermediate risk may be a good outpatient candidate provided he is well, not dehydrated, and follow-up is assured. The child with high-intermediate to high-risk for developing severe hyperbilirubinemia should be admitted for hydration, bililights, and/or assessment for exchange transfusion. The unwell child with or without current neurologic findings should have immediate exchange transfusion. References Benitz WE. Hospital Stay for Healthy Term Newborn Infants. Pediatrics. 2015; 135(5):948-53. Bhutani V et al. Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation. Pediatrics. 2004; 114(1). Bhutani VK, Wong RJ. Bilirubin Neurotoxicity in Preterm Infants: Risk and Prevention. J Clin Neonatol. 2013 Apr-Jun; 2(2): 61–69. Bosschaart N et al. Limitations and Opportunities of Transcutaneous Bilirubin Measurements. Pediatrics. 2012; 129(4). Colletti JE, Kothari S, Jackson DM, Kilgore KP, Barringer K. An emergency medicine approach to neonatal hyperbilirubinemia. Emerg Med Clin North Am. 2007 Nov;25(4):1117-35, vii. Gamaleldin R et al. Risk Factors for Neurotoxicity in Newborns With Severe Neonatal Hyperbilirubinemia. Pediatrics. 2011; 128(4):825-31. Lauer BJ, Spector ND. Hyperbilirubinemia in the Newborn. Pediatrics in Review. 2011; 32(8):341-9. Maisels J et al. Hyperbilirubinemia in the Newborn Infant ≥35 Weeks’ Gestation: An Update With Clarifications. Pediatrics. 2009; 124(4):1193-6. Smitherman H, Stark AR, Bhutani VK. Early recognition of neonatal hyperbilirubinemia and its emergent management.  Semin Fetal Neonatal Med. 2006 Jun;11(3):214-24. Vandborg PK, Hansen BM, Greisen G, Ebbesen F. Dose-response relationship of phototherapy for hyperbilirubinemia. Pediatrics. 2012 Aug;130(2):e352-7. This post and podcast are dedicated to Gita Pensa, MD, for her commitment to #FOAMed and passion for asynchronous learning and education innovation.

Background: Irinotecan-based second-line chemotherapy of metastatic colorectal cancer (CRC) is effective, it might, however, be contraindicated in cases of severe liver dysfunction due to advanced liver metastases. Case Report: A 57-year-old woman with diffuse CRC liver metastases showed progressive disease on first-line treatment with capecitabine and oxaliplatin (XELOX). Chronic cholestasis and hyperbilirubinemia caused by advanced liver involvement prohibited second-line treatment with irinotecan-based chemotherapy. We initiated combined antibody treatment with cetuximab and bevacizumab. Results: Clinical performance status as well as laboratory parameters improved rapidly. Staging investigations after 8 weeks revealed a partial remission. Since bilirubin levels had returned to the upper limit of normal, therapy could be changed to standard irinotecan, 5-fluorouracil, folinic acid, and bevacizumab. Conclusion: Combined treatment with cetuximab and bevacizumab may be considered as an effective treatment option in patients who cannot be treated with standard chemotherapy regimens due to impaired liver metabolism of cytotoxic substances.