Podcasts about kernicterus

How accountable are we when it comes to injuries caused by medical errors? Since this archive episode aired, patient safety remains a serious issue, with thousands of Americans dying from errors in their care. Although interest in improving patient safety has sadly waned, many are working to revive it and increase attention to the problem. In this interview, Sue Sheridan, founder and a global leader of Patients for Patient Safety US, shares how, ever since going through family tragedies caused by medical error twice, she's actively worked to improve and ensure patient safety across the United States. As a newborn, Sue's son's unattended Kernicterus caused permanent brain damage, and some years later, her husband died because of a late-stage sarcoma diagnosis that had been previously detected; after these events, she decided to make a change and share her family's story across health care. However, patient safety has been deprioritized as there are still gaps in the system regarding data collection that can catch mistakes. With Patients for Patient Safety, Sue seeks to democratize patient safety by highlighting transparency, illustrating the magnitude of the problem, and using input from the patient community when coming up with changes or solutions. Tune in to learn more about the importance of patient safety! Learn more about your ad choices. Visit megaphone.fm/adchoices

In this episode, host Keith Woodward talks about Team IMPACT and Michael Torello, who was diagnosed with Kernicterus as an infant, a type of brain damage that can cause athetoid cerebral palsy, hearing loss, and can cause problems with vision and teeth, and sometimes can cause intellectual disabilities, according to the Centers for Disease Control. Carolyn and John Torello, and 2023-24 captain Jayden Lee, join the conversation to talk about Michael's life, legacy, and how his presence has had long and deep connections to the Quinnipiac Men's Hockey Team. Michael passed away in 2021 at the age of 15, but he left behind an incredible legacy rooted in the power of believing, which was a key part of Quinnipiac's championship season. And if you have ever made plane and hotel reservations from a parking lot after a game, The Torellos have a story for you. And we can't resist a plug for www.oldbishopfarms.com in Connecticut, where the Torellos have a farm. All episodes begin with Quinnipiac Student Matt Mungo's call on the Quinnipiac Bobcat Sports Network of the National Championship goal. The Tenth Second is a production of the Quinnipiac University Podcast Studio, and is hosted by Keith Woodward, the university's director of facilities. The podcast is produced and engineered by Justin Moravsky, and is mastered by David DesRoches, the university's director of community programming. Student Jillian Catalano is the social media coordinator. Music is "Running in Circles" by Diane Taylor, used under the Creative Commons license. Additional music from Blue Dot Sessions. Follow us on Twitter and Instagram @TheTenthSecond 

Link to bioRxiv paper: http://biorxiv.org/cgi/content/short/2023.07.12.548684v1?rss=1 Authors: Pranty, A. I., Wruck, W., Adjaye, J. Abstract: Bilirubin induced neurological damage (BIND), which is also known as Kernicterus, occurs as a consequence of defects in the bilirubin conjugation machinery, thus resulting in unconjugated bilirubin (UCB) to cross the blood brain barrier (BBB) and accumulation. Severe hyperbilirubinemia can be caused by a mutation within the UGT1A1 encoding gene. This mutation has a direct contribution towards bilirubin conjugation leading to Kernicterus as a symptom of Crigler Najjar Syndromes (CNS1, CNS2) and Gilbert syndrome, which results in permanent neurological sequelae. In this comparative study, we used human induced pluripotent stem cells (hiPSCs) derived 3D-brain organoids to model BIND in vitro and unveil the molecular basis of the detrimental effects of UCB in the developing human brain. hiPSC derived from healthy and CNS patients were differentiated into day 20 brain organoids, these were then stimulated with 200nM UCB. Analyses at 24 and 72 hrs post-treatment point at UCB induced neuro-inflammation in both cell lines. Transcriptome and associated KEGG and Gene Ontology analyses unveiled activation of distinct inflammatory pathways such as cytokine cytokine receptor interaction, MAPK signaling, calcium signaling, NFkB activation. Furthermore, both mRNA expression and secretome analysis confirmed an upregulation of proinflammatory cytokines such as IL6 and IL8 upon UCB stimulation. In summary, this novel study has provided insights into how a human iPSC derived 3D-brain organoid model can serve as a prospective platform for studying the etiology of BIND Kernicterus. Copy rights belong to original authors. Visit the link for more info Podcast created by Paper Player, LLC

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.

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

"Jeg hedder Sussie og er forlovet med Martin. Sammen har vi Aslak på snart 4 år og Eik på 2 år. Vores historie er desværre en historie om når systemet svigter. Hvor en sund og normal født dreng, qua menneskelige fejl, får en alvorlig og omfattende hjerneskade der har en indgribende indflydelse på resten af hans og vores liv.  Aslak er meget udfordret med flere diagnoser deriblandt kernicterus, svær cerebral parese, svær epilepsi, voldsom dystoni, nedsat syn, hydrocephalus mm.Ingen forventer med rette at få et handicappet barn, drømmen om at få et barn er naiv og lykkelig. Når ens forventninger bliver sønderknust, og man heller ikke har forberedt sig på det værste og så bliver mødt af netop den værst tænkelige besked fra lægen ”hvis han overlever, bliver det med en omfattende hjerneskade”. Så står vi tilbage med en udhungrende, altoverskyggende sorg der ryster vores eksistens fundament, og smider identitet, forventninger og drømme over bord. V Vi klarede os fordi vi skulle, det var ikke et valg for os, men det har kostet os dyrt som mennesker. Det bedste der er sket sidenhen, er at Aslak fik en normal lillebror, Eik. Det lyder forkert men han udfyldte nogle af de savn og tabte forventninger vi havde. Det samspil og den kærlighed de to brødre har i dag er flydende guld og den benzin vi lever af i dag. Alt det til trods er Aslak, når kroppen tillader det, den gladeste, viljestærke og seje dreng. Han har et smil der kan opvarme et rum og gør at han smyger sig direkte ind i hjertet hos dem der bruger tid på at lære ham at kende. Han elsker livet, det bedste han ved er at være midtpunkt ved ethvert selskab. Han gør sig gerne bemærket med høje glade lyde. Aslak tager enhver modgang med godt humør og en kæmpe vilje – selv efter de hårdeste anfald har han overskud til et smil! Han har lært os meget og vi er så taknemmelige for at han stadig er her hos os ❤️Jeg håber du har lyst til at lytte med ☺️

"Jeg hedder Sussie og er forlovet med Martin. Sammen har vi Aslak på snart 4 år og Eik på 2 år. Vores historie er desværre en historie om når systemet svigter. Hvor en sund og normal født dreng, qua menneskelige fejl, får en alvorlig og omfattende hjerneskade der har en indgribende indflydelse på resten af hans og vores liv.  Aslak er meget udfordret med flere diagnoser deriblandt kernicterus, svær cerebral parese, svær epilepsi, voldsom dystoni, nedsat syn, hydrocephalus mm.Ingen forventer med rette at få et handicappet barn, drømmen om at få et barn er naiv og lykkelig. Når ens forventninger bliver sønderknust, og man heller ikke har forberedt sig på det værste og så bliver mødt af netop den værst tænkelige besked fra lægen ”hvis han overlever, bliver det med en omfattende hjerneskade”. Så står vi tilbage med en udhungrende, altoverskyggende sorg der ryster vores eksistens fundament, og smider identitet, forventninger og drømme over bord. V Vi klarede os fordi vi skulle, det var ikke et valg for os, men det har kostet os dyrt som mennesker. Det bedste der er sket sidenhen, er at Aslak fik en normal lillebror, Eik. Det lyder forkert men han udfyldte nogle af de savn og tabte forventninger vi havde. Det samspil og den kærlighed de to brødre har i dag er flydende guld og den benzin vi lever af i dag. Alt det til trods er Aslak, når kroppen tillader det, den gladeste, viljestærke og seje dreng. Han har et smil der kan opvarme et rum og gør at han smyger sig direkte ind i hjertet hos dem der bruger tid på at lære ham at kende. Han elsker livet, det bedste han ved er at være midtpunkt ved ethvert selskab. Han gør sig gerne bemærket med høje glade lyde. Aslak tager enhver modgang med godt humør og en kæmpe vilje – selv efter de hårdeste anfald har han overskud til et smil! Han har lært os meget og vi er så taknemmelige for at han stadig er her hos os ❤️Jeg håber du har lyst til at lytte med ☺️

Cerebral palsy is a group of disorders that affect movement and muscle tone or posture. It's caused by damage that occurs to the immature brain as it develops, most often before birth.   Our guest today is Zain Bando, a Chicago area, 21-year-old college student and is studying journalism at the University of Illinois at Urbana-Champaign as a junior. He hopes to pursue a career in broadcasting after graduation and currently resides in Downers Grove, IL with his family.   TRANSCRIPT:   S8E2 Cerebral palsy Lita T  00:08 Hello, and welcome to another episode of podcast dx, the show that brings you interviews with people just like you, whose lives were forever changed by a medical diagnosis. I'm Lita Ron  00:20 And I'm Ron. Jean  00:21 And I'm Jean Marie. Lita T  00:22 Collectively, we're the host of podcast dx. On today's show. We're speaking with Zain about cerebral palsy. Good morning, Zain. And could you tell us a little bit about yourself? Zain  00:32 Sure. So, um, good morning. My name is Zain Bando And I am a 21 year old college student who's currently studying journalism at the University of Illinois in Champaign. And  after graduation, um I hope to pursue a career in, in broadcasting or as a writer for a sports team. I don't know, I don't know what sports team that would be at. But it's something that I've always been interested in. And it's just a passion that I've always had, and I'm very glad to be pursuing it. So thank you again, for having me on today. I really appreciate it. And sorry, my, my pronunciation is actually "Zain", I know, I know that there's I in my name, but it actually isn't for now, literally. So if you think of the word "van", that's how my name is pronounced. Lita T  01:18 We will take that that I out, thank you very much. Ron  01:22 Yeah I don't know. We appreciate that. Zain. Can you send us out by actually telling us and our listeners what actually is? cerebral palsy? Zain  01:33 Sure, so that's a great question. So according to the Mayo Clinic, cerebral palsy is a group of disorders that affect muscle control, movement, muscle tone, or posture, by injury or malformation, which occurs to the brain as it develops more often before birth during the birthing process, or just after birth. There are two main forms of CP, continental and acquired. Lita T  01:58 Right, right that I've got also in the Center for Disease Control here in the United States. That the risk factors for cerebral palsy, and I'm going to abbreviate it as CP is that it's important to know the risk factors. Some of the risk factors for congenital CP are a low birth weight. So children who weigh less than five and a half pounds at birth, or that's 2500 grams, and especially those who weigh less than three pounds at birth, so that's about 1500 grams, they have a greater chance of having CP, a child that is prematurely born. And that's children that are born before the 37th week of pregnancy, and especially if they're born before the 32nd week of pregnancy, they have a higher chance of having CP intensive care for premature infants has improved a lot over the past several decades. And babies that are born very early are more likely to live now. But many have medical problems that can put them at risk for CP. Another risk factor is multiple births, twins, triplets, and other multiple births have a higher risk for CP, especially if a baby's twin or triplet dies before birth, or shortly after birth. I don't know why that would be but that's what they're saying. some but not all of this increased risk is due to the fact that children born from multiple pregnancies are often born early or with low birth weight, or both children that are conceived with artificial reproductive technology, abbreviated as ART in fertility treatments. Those pregnancies that result have a higher risk of CP. Most of the increased risk is explained by preterm delivery or multiple births or both. And both preterm delivery and multiple births are increased with children conceived with ART infertility treatments. Another risk would be infections that the mother might get during pregnancy infections can lead to increased certain proteins called Cytokines and that circulates in the brain and the blood of the baby during pregnancy. Cytokines cause inflammation, which can lead to brain damage in the baby. A fever in the mother during pregnancy or delivery can also cause this problem. Some types of infections that have been linked to CP include viruses such as chicken pox, rubella, German, which is also German measles, and also Sue-to Jean  04:50 Cytomegalovirus Lita T  04:52 Oh cytomegalovirus Thank you, Jean. And bacterial infections such as infections of the placenta or fetal membranes, And maternal pelvic infec, infections can cause it. jaundice or Jean? Jean  05:09 Nope, I don't know this one. Lita T  05:10 Okay, Ron, Ron  05:12 What are you looking at me for? Jean  05:15 Zain, Lita T  05:16 (laughter) Zain? Karen neck care neck and neck terrorists? Okay, Zain  05:21 I would see. I would say it's um Kernic Esrest, but I'm not sure Jean  05:26  That sounds good. Lita T  05:27 That sounds good. Ron  05:28 That's what we're going with today Lita T  05:29 We're going to go with that  KernicTetris is the yellow color scene in the skin of many newborns. jaundice happens when a chemical called bilirubin builds in the baby's blood. When too much of this bilirubin builds up in the baby's blood the skin in the whites of the eyes might look yellow. This yellow coloring is called jaundice. And when severe jaundice goes untreated for too long, it can cause their condition that Zain pronounced properly and it can cause CP and other conditions. By the way, that condition is spelled k e r n i c. t e r us,  Kernest.. Ron  06:07 I'm going to go with Kerner, Nick terus Lita T  06:10 Kernicterus, Jean  06:11 We're going to have a link on our... Lita T  06:13 Website Jean  06:13 Yes, yeah, Lita T  06:14 That's the best way to go sometimes Kernicterus results from Abo and Rh blood type differences between the mother and the baby. This causes the red blood cells in the baby to break down too fast resulting in severe jaundice. medical conditions of the mother, such as mothers with thyroid problems, intellectual disability, or seizures have a slightly higher risk of having a child with CP, and other birth complications such as detachment of the placenta, a uterine rupture, or problems with the umbilical cord during birth, can disrupt oxygen supply to the baby, and result in CP. Zain  06:55 Well, while that's all true, a small percentage of CP is caused by brain damage that occurs more than 28 days after birth. This is called the acquired CP and usually associated with infection, such as meningitis and head injury, or a problem with blood flow to the brain. cerebral vascular accidents for example, stroke or or bleeding in the brain associated with the blood clotting problem, blood vessels that didn't form properly, or heart defect that was present at birth or sickle cell disease, Jean  07:28 Zain, what are some of the symptoms for cerebral palsy? Zain  07:33 Sure, so because this condition begins to show signs and symptoms at a very early age, and individuals, parents or health care providers typically notice the signs and symptoms of cerebral palsy. The symptoms and effects of cerebral palsy vary depending on the location and extent of the injury to the brain, your child might normal intelligence or have learning difficulties or learning difficulties, your child might have mild difficulties with movement or be unable to control their limbs, despite the variations in symptoms of certain effects are common among people with cerebral palsy. Ron  08:07 Wouldn't you say that it's kind of like a spectrum from mild to severe? Right? Zain  08:12 Absolutely. 100 100%. Right. There's definitely there's definitely a spectrum. Ron  08:18 Yeah, the CD says I'm sorry, the CDC says that in many cases, the cause or causes of congenital CP aren't fully known, which means that currently little can be done to prevent it. CP related to genetics is not preventable. But can acquired CP be prevented? And Zain  08:41 It's a very good, it's a very good question. While there are actions people can take before and during pregnancy, as well as after birth, that might, excuse me, that might help reduce the risk of develop, of developmental problems, including CP, taking steps to help ensure a healthy pregnancy and to help prevent development. developmental problems, including CP acquired CP is often related to infection, or injury, and some of those cases can be prevented, but again, as as it stated, some of those cases just simply are impossible Ron  09:21  Right Zain  09:21 And cannot and cannot be prevented, so Ron  09:24  Right, right. Jean  09:26 Thank you. before pregnancy, it's a good idea to be as healthy as possible. I think that's what a lot of people strive for. And make sure that any infections that you might have are treated in any healthcare conditions that you might have like diabetes are under control. And ideally, they should be under control before you. You will conceive if if  assistive reproductive technology or ART infertility treatments are being used to get pregnant, consider ways to reduce the chance of multiple pregnancies, twins, triplets, or more. I think some people think Up to like 1213 children at a time, such as transferring only one embryo at a time. And then having multiple pregnancies. It's also important to get vaccinated for certain diseases as Lita had mentioned, such as the chicken pox or rubella. And that could, those if you should contract those illnesses while  pregnant, that could be harmful to the developing baby. It's also important to have many of these vaccinations before you become pregnant. And as we've learned Also, before you have an organ transplant, or any of those things as well, for undertaking any major life changes, Lita T  10:38 Right. And during pregnancy, you should have early and regular prenatal care, both for your health and for the end of your developing baby. You should wash your hands often with soap and water to help reduce the risk of infections that might cause harm to your developing baby. Contact your health care provider if you get sick, have a fever or have other signs of infection during pregnancy. a flu shot is your best protection in our in our opinion, against serious illness from the flu, or flu shot can protect pregnant women and their unborn babies, both before and after birth. flu shots have not been shown to cause harm to pregnant women or their babies. If there is a difference in the blood type, or the Rh in compatibility between the mother and the baby, like we said it can cause jaundice and Kernicterus. I'm not going to get that one Ron  11:32 (laughter) Jean  11:32 Nope  We'll hear about that later. Lita T  11:34 Yep, women should know their blood type and talk to their doctor about ways to prevent problems. And also you should talk to your doctor about ways to prevent problems if you are at risk for preterm delivery, such as if you have multiple embryos. Research has shown that taking magnesium sulfate before anticipated early preterm birth reduces the risk of CP among surviving infants. Zain  12:00 And in addition to that, it also leaves reducing risks after the baby's born, because any baby can get jaun jaundice severe jaundice that is not treated, can cause brain damage. Just like the mom before pregnancy makes sure your child has vaccines against infections that can cause meningitis. And with it, we'll see if I can get this one, um encephalitis   Buckling their child in the car. Buckling their child in the car using an infant or child car seat, booster seat or seat belt according to the child's height, weight and age. Again, this is just our opinion of recommendations that should be done. Make living area safe. Make living areas safer for children by using window guards. Keep young children from falling from falling out of open windows and using safety gates at the top and bottom of stairs. Make sure make sure the surface of your child's playground is made of a shock absorbing material such as hardwood mulch or sand, carefully watching children at the time. At all times are in bathtubs swimming or wading pools, and natural bodies of water that should that should just go for any young child in general disability or not. Adults watching kids in the water should avoid distracting activities like using a computer or a mobile device reading or taking or talking on the phone. Talking on the phone might be the most dangerous one, in my opinion. Jean  12:24 Yep right on Yeah, Zain  12:52 Make sure your child wears a helmet. For activities like riding a bike. That's an obvious one. And of course, never hit, throw, shake or hurt a child. I know the sound like common sense things, but some young mothers may not know how dangerous life is for a very young child.  That's right. Great advice  Zain. As a matter of fact, I just heard on the news that they they are trying to reach out to very young mothers mothers that really don't have perhaps a mentor. They might be on their own. They don't have the the background and those type of mothers. They just might not have all of these tools at their disposal. So hopefully this episode will help them Jean  14:14 Yeah, not everyone's been you know babysitting. Yeah, Lita T  14:17 Yeah. Great. Zain. What treatments are available for somebody that's been diagnosed with CP ? Zain  14:24 For sure, um, There are medications that can help with the muscle spasticity. In July of this year, the FDA has approved an expanded use of Dysport to treat upper and lower limbs spasticity which I actually did not know about, including that caused by CP for patients as young as two years and older. Overtime, CP might cause problems with muscles, bones and joints in your child might need surgery to address these issues or concerns. Ron  14:54 Right Right, Zain. What tips do you have for someone whose child has recently been diagnosed with CP Zain  15:01 um while there's still an ongoing education process to be have to be had just from my own personal experience, I would not recommend panicking. If you can find the right resources available to parents out there today. them from when I was born 21 years ago that I think that's key just because the world is evolved so much in that time. I see having a trustworthy doctor and focusing on the things that the child can do is a key to begin a positive outlook on life. For sure. Ron  15:32  Right. Lita T  15:33 That's great advice. And what would you What have you found to be the most common misconception about CP? Zain  15:42 I've noticed that a lot of people think that the people were born with CP are born exactly the same way. So I would say every person is born with it. So I would say the biggest misconception that people have is every person born with it as the same journey of life. While in actuality, people want to live with the condition and focus on the things they can control. Ron  16:05 I like this kid. Lita T  16:07 He's got a good he's got a good future ahead of him Ron  16:10 Got a good outlook. Yeah, I mean, that's exactly we focus on what we can do not what is difficult or what we can't do. Lita T  16:16 Right. Ron  16:16  So I love the way you view that. Your outlook, Zain, um, how about your friends and family? What kind of role have they played in your life? And do you have any other support systems that you found to be helpful? Zain  16:30 Yes, um thankfully, I have a good support system, both from friends and family. They've been extremely supportive in all my endeavors. Anything for me, scuba diving over a decade ago to participating in athletics as a social media manager in high school, or for the football and basketball teams, they've always been there. I also think that surrounding yourself with positive people will only make life more fun. And I've also recognized that focusing on your inner self motivation, working out meditation, any of those things, is also a good way to reset and focus on your whole self too. Because at the end of the day, what's inside you, in my opinion is most important. So Jean  17:13 That's, that's fantastic. And I have a question. You're a Downers Grove North grad. Is that correct? Zain  17:19 I sure I sure am absolutely. Jean  17:22 We have three my my Lita's three grandsons all went to Downers Grove north too so you guys are all in good company.  all, Alumns. Yes, all Alumns, I have a question. So what first interested you in journalism? And then what drew you specifically to sports journalism? Because I hear we actually read some of your some of your articles for Downers Grove North? And I'm just curious what first inspired that? Do you have like a favorite journalist? Zain  17:49 Sure. So um, I mean, when I was in high school, I knew I wanted to do something. um in sports. Because um in middle school, I had been a public address announcer for the middle school basketball teams. And I knew I wanted to do something similar in high school, because of course, I can't physically play organized athletics. And when I was a junior in high school, I took a intro to journalism class. And thankfully, the teacher who's actually the current head softball coach, there was really big into sports and kind of drew me into the entire industry, Jean  18:26  Okay, Zain  18:27  And I took in all and I took in all the knowledge, and I just knew  that's the path I wanted to pursue myself on. And, you know, thankfully, I was able to be given all these wonderful opportunities, and I owe a lot to him and, and of course, I owe a lot to, to my head coaches, that I was able to help out as a manager for varsity football, varsity basketball my final two years there, and you know that North's a place that's always going to be it's always going to be with me for a very long time. And I'm always going to consider Downers Grove home. So it's been a it's been a wonderful experience and a very, very good question. Lita T  19:05 That's great. Yeah, I have another follow up. I'm sorry. Ron  19:09 And I have a follow up your follow up. Jean  19:10  (laughter) Lita T  19:10 Ok alright Ron  19:11 (laughter) Jean  19:11 And then I have a follow up Lita T  19:12 Alright Zain, You got us going here. Do you have a podcast yet? Zain  19:17 Um, I did a very long time ago. At the moment. I have one right now. It's called Sports. Talk From A to Z. It's a podcast with me and my college roommate. Um, you can find it on YouTube by searching Sports Talk From A to Z, we talk about everything from sports, to social justice issues to things that we don't like with commissioners. It's pretty it's pretty interesting. Ron  19:42 (Laughter) Sorry to laugh. Zain  19:45 Yeah, we have. There's a lot there's a lot packed into it. We have about like 17 episodes or so. Lita T  19:51 That's great. Zain  19:52 We took a break for we took a break from it for a little bit. We're hoping it start it up again in the next couple weeks. Because of we really like doing it. And then I'm also a freelance writer for Insider.com I cover Illini-athletics and mixed martial arts. So if anything from the UFC Bellator and numerous other MMA organizations, I write about them as well. So I'm around, kind of in a couple of different media spaces, and I'm pretty easy to reach to. And we'll get to that near the end of the episode. Lita T  20:24 Right, right, right, I just, you're just the way you're carrying the way you're carrying us through this episode. I wish you were running our pockets. (laughter) Ron  20:33 I told you I like this kid. Lita T  20:34 Ohhhh Ron  20:35 So, you know what, I'm gonna probably show some of my ignorance over here. You're from Downers Grove. And we are basically in the Chicago region. I'm not a huge follower of follower of the White Sox. But I do know that the Chicago White Sox baseball team has an announcer that has CP I don't recall the gentleman's name, but have you ever reached out to him for any advice? Zain  21:01 It's a very good question, as his name is Jason Benetti. He's a wonderful announcer. Unfortunately, I've tried reaching out to him multiple times. But um, you guys may not know this. He's a very, very busy person. Not only does he do White Sox baseball, he does college football and during his, big time college basketball games, through the winter months. I've tried a couple of times, things just haven't worked out. But I'm very hopeful that we can cross paths. And some day because he does have the same disability. I do. And he does tremendous work. And he's just somebody that I think a lot of people in the sports industry should continue to work up to, because he's going to be either the next generation of people that are going to be coming through the pipeline. So thank you again, for for mentioning that. Yes. I'm very well aware of who Jason Benetti is. Ron  21:53 Okay. Cool. Cool. Cool. Cool. Jean  21:54 And then I have another question. He had several questions. I try to limit it. Sorry. Ron  21:58 (laughter) Um, he's like, are these people done yet? Jean  22:01 Um, so Zain, what is it been like, at the university with COVID? And everything? And how is learning changed? Zain  22:09 Um, I mean, it's been interesting. I actually decided to stay home for the semester because of COVID. But I think overall, the university has done a tremendous job with the revolutionary saliva test, they've been able to make it through the entire semester. And I'm looking forward to going back in the spring and just seeing what a COVID semester is going to be like, because I think we're going to be with this virus for a little bit. And, yeah, I think, I think it's just one of those things that where we kind of all have to get through it and stay positive and again, like, kind of the theme of this episode has been, we need to control what we can control at this point. And yeah, absolutely. Ron  22:48 Okay. Speaking of control, I'm going to take control the mics right now I'm gonna cut off Jean and Lita, we're gonna wrap this up. And we do appreciate your time. But one thing I did want to talk about, I think somebody earlier mentioned something about water, or Dive or Dive Heart. But I know, you've been with an organization called Dive Heart that does scuba diving for children, adults and veterans with disabilities. But is it more than just jumping in the water or breathing underwater, does it? How much more does that affect you doing that sport? Zain  23:31 Well, I mean, that's a great, that's a great question. First off, they've always been in tremendous organization. They, they, they gave me You know, they give people opportunities where they don't feel like they have kind of an avenue to go through. And that's one of the things that I felt when I was younger when I did it. So the freedom of movement underwater is one of the most satisfying things you could ever have. I think scuba is less about the act of getting underwater, and feeling relaxed, and more about all the prep stuff, the teamwork, the communication associated with being able to work with a group of experienced divers being able to learn all the different equipment and kind of what the kind of what the rules and regulations are and just being with people who are going to be there that are going to be able to support you as you kind of feel the freedom underneath underneath the water. And for some it's an exhilarating feeling because when they're out of the water they don't they either they either don't feel that movement or sensation or it's very difficult for them. So that's something that's something that I've noticed, just simply doing the sport and being a part of it for for as long as I was. Ron  24:50 That's great. That's absolutely great. Thank you. Thanks so much for that. Jean  24:54 And Zain. How can our listeners learn more about you, um, you were talking about how you have a you know, there's a Spots Talk From A to Z on YouTube. Do you have any other social media accounts? Zain  25:06 Oh yeah, you can find me everywhere on all the major social media platforms from our Instagram, Twitter and Snapchat, or my handle was @ZainBando99 that's  Z A I N B A N D O nine, nine. You can follow me on all of those. My DMS are always open. If anyone would like to talk, I'm always active via all those all the time. I'm actually a huge social media junkie so you can find me uhh you can find me anywhere. Jean  25:36 So I want to put them in charge of the podcast. (laughter) Yeah. And, and our social media. Yes. Ron  25:41 And my archery website. Lita T  25:42  Right, right. Right, we're gonna get you going, Jean  25:44 You're gonna be busier than, than Jason, Lita T  25:47 Thank you. Thank you so much for joining us today's Zain we really appreciate it. Zain  25:52 Oh, you're welcome. Thank you guys for having me on. Again. I was really happy that we were able to do this. And you go, I think you guys will continue. And you are continuing to do a good job of giving another platform for people to listen to before they can go out and make their own make their own decisions on what's best for them medically. So kudos to you guys for that and thank you again, you guys did a tremendous job and kept me entertained the whole time so thank you Lita T  26:20 (laughter) Ron  26:20 We're nothing if not entertaining. Lita T  26:21  Oh yeah. We don't charge extra. If you have any questions or comments related to today's show, you could drop us a line at podcast dx@yahoo.com through our website, podcast dx.com and Facebook, Twitter, Pinterest or Instagram. Ron  26:38 And if you have a moment to spare, please give us a five star review wherever you get your podcast. As always, please keep in mind that this podcast is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition or treatment, and before undertaking a new health care regime, and never disregard professional medical advice, or delaine. Taking it because of something you've heard on this podcast Jean  27:09 Till next week.

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.

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.

About 60% to 80% of newborn Infants in the United States are jaundiced, that is they look yellow. Kernicterus is a form of brain damage caused by excessive jaundice. The substance which causes jaundice, bilirubin, is so high that it can move out of the blood into brain tissue. Join Dr. Shapiro as he speaks with Transformational Pediatrics about the diagnosis, treatment and research supporting the pediatric population with kernicterus and other bilirubin-induced neurological disorders.

Neonatal jaundice is predominantly a benign condition that affects 60%–80% of newborns worldwide but progresses to potentially harmful severe hyperbilirubinaemia in some. Despite the proven therapeutic benefits of phototherapy for preventing extreme hyperbilirubinaemia, acute bilirubin encephalopathy or kernicterus, several low-income and middle-income countries continue to report high rates of avoidable exchange transfusions, as well as bilirubin-induced mortality and neurodevelopmental disorders. A review recently published in ADC examines the contributory factors to the burden of severe hyperbilirubinaemia and kernicterus and provide strategies for improving care. ADC Global Health editor Nick Brown talks to co-author Tina Slusher, Department of Pediatrics, University of Minnesota & Hennepin County Medical Center, Minneapolis, to hear what they suggest. Read the full paper: http://goo.gl/7fO5h1