Approach to persistent and prolonged neonatal jaundice. Dr Sridhar Kalyanasundaram
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- čas přidán 15. 03. 2021
- Neonatal jaundice is one of the commonest problems in neonatology, and is addressed in detail in the earlier video on my channel ( • Neonatal Jaundice-appr... )
In this video, I discuss the practical approach to prolonged (and persistently high) neonatal jaundice. The most important consideration is to rule out risk of conjugated jaundice, especially biliary atresia which needs to be diagnosed in a timely fashion to avoid poor outcome. I hope this is helpful, please share.
Do review this detailed video on neonatal cholestasis. • Approach to Neonatal c...
#persistentjaundice #prolongedjaundice #conjugatedjaundice #cholestasis
For new parents, I request you to review the following playlists
Snippets for new parents czcams.com/play/PLKe2uxLSi6cEAuXao6M9lsXUmbyhbpL1t.html
Breastfeeding-czcams.com/play/PLKe2uxLSi6cFdnNrlnJQ8T5P-qaP8erc5.html
Quick snippets on infant feeding czcams.com/play/PLKe2uxLSi6cEBZDvubZd47QlUoTrpKZS8.html
Infant formula feeding czcams.com/play/PLKe2uxLSi6cE4xpiFAAB28mTY9VuQNe49.html
Nice video and throughly explained
Best wishes
Very nicely explain sir thanks
Best wishes
Dear Dr.Sridhar K. You have great videos with very important and valuable information. I am a pediatrician but difficult to follow. I would be great if you mount PowerPoint-like slides
with text and figures while you narrate.
Thank you. I have many PowerPoint presentations as well but for short videos, I find it easier. Your feedback is appreciated, thank you
I have created a playlist now with the powerpoint based presentations on this channel (my own-most of the expert talks are powerpoint based too)-do review these. czcams.com/play/PLKe2uxLSi6cG5ALQUZVs115eBMgPqII07.html
Thanks sir.. Sir.. can we differentiate by skin color the difference between conjugated and unconjugated NNH.... also difference in stool color of EHBA AND CHOLEDOCAL CYST.
Hi, babies with conjugated jaundice have a sick looking pale green hue to skin. Regarding the latter part, it can be intermittently pale in choledochal cyst but I am not sure about color difference
Very Informative Dr ..thanks a lot
Thank you
Please, is phototherapy indicated after 7th days of life, if indirect bilirubin is highly??
Normally you continue to follow the same threshold to treat as by 7 days, but if using the NICE charts, you can progress to the next maturity level
Quite useful info
@@vankayalaravi1 Thank you Ravi
Namesthe doctor
Im writing from vizag
My baby boy is currently 17 days old
On day 3 we did bilirubin test his total bilirubin was 13.5
So immediately we have given phototherapy for 24hrs
It came for 10 level so doc stopped phototherapy and got discharged
Again on day 15 of live when we went for a followup doctor advised for a retest
Total bilirubin was 20.0 unconjugated 18.9 conjugated 1.1 again started giving phototherapy for 24 hrs total bilirubin was 11.3 direct was 2.0 indirect 9.3 LFT was all Normal thyroid profile normal no RH compatibility, complete hemogram also normal, serum C reactive protein also normal sir.
Again after 20 hrs of stopping phototherapy he is looking again bit yellowish.
Im just worried wat is happening to him. His stools are yellow urine also normal color. He is exclusively breastfeed from date of birth. Im producing more than enough breastmilk. Activity is also good sir.
Is it breastmilk jaundice
If so
Should i continue breastfeeding or should i Stop it for time period sir.
Please reply sir
Thankyou.
@@nireekshnajyothikosanam738 please continue breastfeeding, repeat total and direct bilirubin and if possible, test for G6PD as well. Direct bilirubin often rises together with total but it should be reducing now. You can share the repeat results here too
My new born is 3 weeks old and her jaundice is not getting any better but worse. She was born at 37 weeks, she's breastfeeding. Jaundice started on 3rd day of life. Her doctor has done pretty much all tests and says she's healthy. She's been under phototherapy twice, first for 6 days, stayed home for 3 days it went back up and went in for 4 days, got discharged and I can tell its getting worse again....I'm getting depressed
It is most likely breast milk jaundice which is likely to resolve with time. Hope the direct bilirubin and thyroid function are normal. Some increase from the level when phototherapy was stopped is expected but as long as it’s not rising now, don’t worry. Review this Breastmilk jaundice. Breastfeeding jaundice. How do we manage breastmilk jaundice. Dr Sridhar K
czcams.com/video/mftsNiqyPEM/video.html
Dear sir,
While work up of a 2 week old term neonate for prolonged unconjugated hyperbilirubinemia, we found that the neonate had mild normocytic normochromic anemia (Hb- 12.9 g/dl). Work up has ruled out hemolysis. The neonate is asymptomatic..how to go about regarding this finding..can I label this as physiologic anemia of the neonate?
This Hb is quite normal at this age, as you said it is most likely physiological anemia
Hello sir ..my baby is 3.5 month old ..she have prolonged jaundice... pediatrician told to have thyroid test ..she have subclinical hypothyroidism...her treatment is started for thyroid replacement...its 20 days now but she is little yellow till .. liver functioning is normal .. when she will recover .. how many days it will take
Continue to monitor, continue treatment
Sir, My baby boy has G6PD deficiency (0.47). At 31days old bilirubin is 14 but direct is 0.4. I want to know if we can use baby care products like cream, powder, oil, soap of easily available brands like Himalaya. If not then what to do?
I don’t think there is any issue with using these products. Continue breastfeeding and repeat after 2-3 weeks
Hello sir my baby is 21 days old and his blurubin is total is 10.19 and direct is .75 and blurubin indirect 9.44.
Is there any problem
It’s ok, hope you had the thyroid tested earlier as well
Useful playlists for nicu nurses, trainee pediatricians and neonatal trainees
NRP-czcams.com/play/PLKe2uxLSi6cErI1Y7ZRbLub-1Qq8AT4Bm.html
Oxygen in Neonatology czcams.com/play/PLKe2uxLSi6cEDL9Zfc57-YJjlVkqJXmQp.html
Neonatal ventilation-czcams.com/play/PLKe2uxLSi6cEk8ExzMpF-5ePzmkteTNjk.html
Neonatal jaundice-czcams.com/play/PLKe2uxLSi6cFT5aOxCrU9ENBRXlkUwWzq.html
Breastfeeding-czcams.com/play/PLKe2uxLSi6cFdnNrlnJQ8T5P-qaP8erc5.html
And many short videos to clarify queries of new parents-could help if you cover postnatal ward czcams.com/play/PLKe2uxLSi6cEAuXao6M9lsXUmbyhbpL1t.html
Thank you for this video Doctor.
My son is now 39 days old. He was confined when he was 8 days old due to hyperbilirubineamia. After 1 week (14 days old) he was discharged and his color went back to yellow.
On his 20th day, his bili results are:
Total bili: 187.59 umol/L
Indirect bili: 185.02
Direct bili: 2.57
Recently (on his 35th day) he was diagnosed with anemia. With these results
Hemoglobin: 91 g/L
Hematocrit: 26.10 vol%
He was given iron supplement by his pedia.
He is pure breastfeed but feeding is good, always latching with good sucking. He is also receiving milk from other moms. His poop is yellow but
Up until now, he's yellow. His eyes are yellow. It's not improving. I am very worried because he is very fussy and irritable. Sometimes I also think that he has involuntary movements specially his mouth and neck. His feet are also stiff sometimes especially when he cries.
It's depressing.
I hope to hear from you Doctor. Thank you
Did they repeat total direct bilirubin at day 35? Hb 9 is normal at this age, it will start increasing now.
The other aspects could be reflux related. Review the videos in this playlist and focus on feed pattern (with spacing) and avoid overfeeding
Reflux in babies
czcams.com/play/PLKe2uxLSi6cHs4XfNhh9bWcZU78FNAFU-.html
Thank you Doctor.
We repeated the bili test yesterday.
Total bili: 181 umol/L
direct bili: 10
Indirect: 171
@@jmptrading it’s stable, repeating both blood counts and bilirubin after 3 weeks or so is fine
Dear sir is there any role of sunlight in treatment of jaundice.it is often asked to expose the child to sunlight will help resolving the jaundice?is it recommended?
If we are sure it is physiologic jaundice, there is no harm as many cultures believe in it, and that was how phototherapy was discovered. However, we should educate on importance of monitoring and if high, no role in treatment. Phototherapy would be needed. It should never delay proper treatment
Sir my baby is 4 month he jaundice from birth what should i do
Please give more details.
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Wht is the normal range of direct bilirubin plz rep??
Please tell me the total and direct values
@@SridharKs 23march ko krwaya ha test
Total bilirubin 13.1
Bilirubin direct 0.9
Indirect 12.2
@@LearnDreamInterpretation this is ok, just monitor, continue breastfeeding
@@SridharKs thanku sir God bless u
Is it enough to send CRP instead of urine routine and culture 🤔?
No, UTI can be silent. But you don’t need it in all cases, only where direct bilirubin is high or persistent (not in all babies with prolonged jaundice), or if excess irritability or poor growth
My last baby died at 6 days old of Kernicterus. Trying to do everything we can too keep this next baby alive and well. Wondering if I should supplement with formula the first few days at least until my milk comes in. He'll have hemolytic jaundice due to my Rh blood type sensitization. Thanks for this info!
Really sorry to hear that. Was it due to Rh isoimmunisation? If you book in a center with fetal medicine support, they can monitor and consider in utero transfusion if signs of fetal anemia. If no option, better to start intensive phototherapy from the start, and if rising (or if cord levels high), consider IV immunoglobulin. Where do you live
@@SridharKs Yes, that was the cause. We're in Cambodia now. They are monitoring baby's middle cerebral artery for signs of fetal anemia and so far he's healthy and strong and measuring well for his size. His sister who died was born completely healthy too despite the fact that my antibodies were at pretty much maximum levels. So it seems that again it's mainly the after birth care that is critical. They have bilirubin lights and we'll request those immediately. I have no troubles breastfeeding, but I wonder if I should supplement with a bit of formula additionally those first few days until my milk comes in. Our last baby went downhill on day 3 despite feeding really well. I'd like to avoid a blood exchange. Though my husband has donated blood for the purpose. We bought a transcutaneous jaundice meter in case the hospital doesn't have one.
@@SridharKs I wonder if IV immunoglobulin might be a good idea on the first day to prevent a huge rise in bilirubin. By day 3 last time she was at max level bilirubin(50mg), but that was without bilirubin lights. The first blood exchange brought her down to 25, but it was too late the bilirubin had crossed the blood brain barrier, she started having seizures. That was with no one treating her for jaundice at all though until day 3. The doctors said it absolutely shouldn't happen again, but of course we're terrified.
I am sorry for what you went through. It is certainly a good idea to start intensive phototherapy and consider IV immune globulin if rising fast in first 12 hours. Topping up with formula till you get milk (start expressing soon after delivery) should be ok
Did you mention it was Rh incompatibility
Sir my one month old baby suffering from jaundice it's visible till now as we have not tested as doc said it will go away and it's mild..lft done at one month total bilrubin 7.3 direct bilrubin 2.0 indirect 5.3 sgot 49 sgpt 11 alkaline phosphate 130 protein 5.20albumin 3.6 globulin 3.6 A.g ratio 2.25 TSH 2.85 sir pls tell I am worried what to do...how much time it will take to subsidice
How is the stool and urine color? Direct bilirubin is on higher side. We need to repeat in 4-5 days and if still in that range, we need workup including urine test and ultrasound
Stool is yellow bit loose from 3 days with seeds like 3 to 4 and urine colour is fine breast feeding
@@alokpandey1533 ok, as above
Dear sir, my daughter tested billirubin 13.4 on 8th days, gestational age 37, birth weight 2.5kg. with mother and baby both A+ve. Tsh,FT3,FT4 normal. On 25day total billirubin was 200 and direct 23Micromol/l. AST 39 n ALT20 U/L but ALK phosphate raged to 429. On torch test IgM negative but rubella IgG n cytomegalo IgG positive. What does this indicates? Will jaundice be recovered naturally@
Hi, you can ignore my question in the other video. Thyroid function normal, normal direct bilirubin and baby thriving. Nothing to do except repeat total direct bilirubin after 2 weeks. Continue breastfeeding. The antibodies are related to mother being immune, alkaline phosphatase is high at this age, continue vit D
@@SridharKs Thank you so much sir. So we can consider, the jaundice even after 2weeks are nomal if test are fine.
@@mrdraj100 yes, if reducing it’s fine
@@SridharKs sorry sir, to bother you again but, if IgG is +ve, what is the significance of cranium usg n ecg; also necessity of SGOT and SGPT again.in 1 week
@@mrdraj100 igG is not suggesting baby infection. I don’t do ultrasound in such cases. You could do full lft in 2 weeks
Hello sir... I’ve a humble suggestion( assuming that this video is for the parents). It would be highly appreciated if you could have a pictorial demo along with the audio, at least text. I’m saying this because people don’t seem to understand anything after counselling sessions for parents whose babies get phototherapy in my work place even after talking in simple language in their mother tongue.
But if your intended audience is professionals it’s ok. We enjoy this. But it be better if you could include text at least.
Thank you-this was more for professionals as I mentioned. And regarding the format, I use a mix of both as you would have noticed and in the short talks, I am including some pictures on the thumbnail. I am not an expert at video editing, so learning still.
Dr Dileep, really appreciate all your constructive feedback from the very outset! Thank you
Hi sir my baby is 45days old .usko 40days se jaundice ha .bilirubin was 19jb admit kia 3din ma 9.5hogaya discharge kr dia .but ghr a k 7din bad 13hogya or still 13he ha but wo thek nai ho raha full yellow ha .Kya mujhe uska breast milk churwa dyna chaiye??plz rep kr dain bht preshan hu ma
If fully breastfeeding, it is okay if rest of liver function is normal and thyroid as well. Review this Breastmilk jaundice. Breastfeeding jaundice. How do we manage breastmilk jaundice. Dr Sridhar K
czcams.com/video/mftsNiqyPEM/video.html
@@SridharKs sir plz rep main bht prsesahn hu kuch guide kr dain bilirubin direct or indirect ka lavel bhj dia ha apko comment ma
@@LearnDreamInterpretation I replied
Hello doctor, my baby was born at 37week GA, and he got jaundice on the 3rd day level 17, and after keeping in phototherapy it was 14 so we took our baby home, and again after 2weeks my baby jaundice increased to 23.9, and again we did phototherapy and decreased to 15, my baby is 1month old, but still my baby skin is yellow, what is the reason for jaundice being relapsed? Pls help doctor
Please ensure direct bilirubin is normal, and thyroid levels are ok. What is the last result? Are you fully breastfeeding
Doctor thyroid is normal and direct bilirubin is 2.7 and I am breastfeeding and last total bilirubin was 16
@@alicesubba277 direct bilirubin is slightly high, when are you repeating
Day after tomorrow I am taking Jim’s to hospital
Him*
Hello sir, my new born baby is 1weeks old and her jaundice is not getting better but it’s getting worse, she was born at 38weeks and she is on breastfeeding. Her jaundice start showing on 3rd day of life, and doctor has done the all test n jaundice was shown at 12mg, doctor suggested us to keep her in under phototherapy for 24hours. After the phototherapy my baby jaundice goes down and it was like 8mg and doctor said it normal level and she was discharged. Now her face is getting yellow colour at her face and her eyes too.. i think her jaundice is getting worse now a days. So,should go and see doctor or is it normal
Nothing to worry, the level is fairly low and it’s normal for it to increase gradually after stopping phototherapy. Check level again to monitor but if it’s below 15, nothing to worry (treatment not needed below 18-20). Review these. Quick overview of neonatal jaundice part 1 #neonatology #nicunurse #jaundice #phototherapy
czcams.com/video/nG3jxlN7UoA/video.html
Quick overview of neonatal jaundice part 2 #nicunurselife #education #jaundice #neonataljaundice
czcams.com/video/qKKziOW2qr8/video.html
Dear dr... Actually my son is suffering from prolonged jaundice... Still he 21 days old and the current total billirubin is 11.37 mg/dl and my babys dr has advised me to go for the lft and thyroid test and sir i did everything accordingly as per the test report tsh t3 and t4 was completely normal but there is the something in lft like the total protein is 5.5 gm/dl serum globulin is 1.4 gm/dl ... Sir what is your suggestion I am in a complete stress please sir have a look
And sir one more important thing that i forgot , unfortunately my son is suffering from rh incompatibility ... Her mother is 🆎negative and the baby is B positive➕
@@aazadbashir8160 Hi, this level of jaundice is quite common, and the doctor has rightly advised the tests-the most important test is direct bilirubin, since you didn't mention, I assume it is normal-what was it? Is your baby fully on breastfeeds?
Please review this Breastmilk jaundice. Breastfeeding jaundice. How do we manage breastmilk jaundice. Dr Sridhar K
czcams.com/video/mftsNiqyPEM/video.html
Yes dear dr my baby is fully on breast feed and sir his direct billirubin is 0.61 mg/dl ... Sir kindly reply
@@aazadbashir8160 you can review the video from the link I shared. Nothing to worry, continue breastfeeding and repeat liver function in 2-3 weeks. If improving, no further tests needed. Slightly low protein is normal in babies
Sir my baby is 23 days old isko abhi b juiandace hai lft krwaya abhi 12 points hai ot pt is also.raised
If OT PT is slightly raised, it is okay to monitor-what is the direct bilirubin? Is the baby stool colour normal, was thyroid function tested (or was newborn screening done)
Sir ot is 132 pt is 55
O.73 is direct billurubin
Thyroid is normal 3
@@sheebuhussain9495 Don't worry, it is okay to monitor and repeat liver function in 2 weeks or so, and if reducing well then, you can stop monitoring
Hello Dr. My son is 6 weeks old... His TCB level is 136.. His stool colour is yellow.. He is taking breast milk only... But his umbilicus is slightly bulging... He is active... In this week his TCB is normal? I am little worried about because His eye is slightly yellow not even mild... Please reply me
I had responded earlier, better to do thyroid function and liver function and if normal, nothing to worry
@@SridharKs here I shown one peadtricion. He said no need to do the test. His skin colour is normal and stool colour also normal. Can go 2nd opinion
@@pradeepafromksa4121 in majority of the cases, it will be normal. But if abnormal, it is something where delay is dangerous. It’s a simple blood test, but it’s your decision. It’s not a question of second opinion, it’s a question of doing a test to rule out concerns
@@SridharKs OK sir. I will do the test n send u the results
Hello Dr. His total bilirubin 149
Direct bilirubin is 11. 90
Dr my child is 48days old. His total bilirubin level is 11.4 and indirect bilirubin level is 11.still baby has mild yellow colour in skin. What can I Do now.
The direct bilirubin is normal (0.4). I suppose you are breastfeeding. Nothing to worry, review this Breastmilk jaundice. Breastfeeding jaundice. How do we manage breastmilk jaundice. Dr Sridhar K
czcams.com/video/mftsNiqyPEM/video.html
@@SridharKs thank u very much doctor🙏
@@SridharKs doctor I think my baby has breastmil jaundice. How many days it will take to reduce and to become the baby to normal colour what can I do for this
@@malshakaluarachchi3041 it might take 2-3 months to resolve, nothing needs to be done apart from ensuring normal thyroid function and maybe a repeat liver function in 2-3 weeks
Doctor Thyroid function test results are normal. Is it necessary to do AST, ALT or SBR only
Hello sir,my sister baby having jaundice total tsb -22 ..on 5 th day .. is it high level ?? Baby has admitted in hospital..now..for photography..does it affect Brain..baby is sleeping on morning ..at night she is awake ...is there any test required to do...plz reply
So it rose from 15.6 to 22 in a day? Was the 22 on a skin test, the blood test could be lower. This definitely needs treatment, and a review of factors that could increase the jaundice. Sleep pattern like this is common in babies, not related to jaundice. Hope baby is otherwise well
Tsb tested by blood test..
@@surekhajadhav6864 ok, hopefully will come down with phototherapy. Is there any other risk factors
What are the risk factors for neonatal jaundice? #jaundicetreatment #neonataljaundice
czcams.com/video/dhaQvnAfIrI/video.html
Hi sir plz help my 6 month old baby has suffering from lots of vomiting like milk reflux.. his weight is 6.7 kg birth weight 3.2kg ta it's normal weight or not plz tell me sir..I try each & everything but not working..he throughout very very milk after every feeding ..we can also hold in upright position for 45 mints after every feed .. plzzz sir help me milk reflux prblm can be caused any diseases infuture plz tell me????? How can solv ths prblm
Sir it's big big request plz reply once.. sir please I need suggestions sir medicine and jr.lanzole tab not working for vometing what test should I do ? For my 6 month son for finding how deep it is.
Plz plz give me advice sir also plz send how we contact you sir plz tell us..
@@sadafjagirdar6859 you can reduce milk and progress with solids. Weight gain depends on many factors, better to monitor on growth chart. What did your doctor say about the vomiting? Don’t force feed thinking about weight gain. Review the videos in this playlist Reflux in babies
czcams.com/play/PLKe2uxLSi6cHs4XfNhh9bWcZU78FNAFU-.html
@@SridharKs hi sir thank you for reply..my doctor say it is a physiological prblm it's completely solved when lower eshophegus matured after one year so wait for year hi said. Sir I introduce solid food like rice moong dal wheat cereal and giving aptamil gold formula for her..
But he vomit after each & every meal sir what should I can give him for bosts her immune system.. also he suffers from every alternate days caugh block nose and cold sir hi gulp vomiting very badly also... Plz tel some diet chart for acid reflux baby
@@sadafjagirdar6859 are you waiting long enough between feeds? No force feeding? What is weight gain in last 2 weeks
@@SridharKs hi sir I give him feed after every 2_3hrs .. I don't give him forcefully feed sir.. 6.550 kg weight before 3weeks he only put 150gram know .is it normal sir??
Dr my child is 48days old. His total bilirubin level is 11.4and indirect bilirubin level is 11.direct bilirubin level is 0.4.what can i do now. Pls help me
Responded to other message
47 days baby( 3.9) mg/dl
Is it normal
@@abinayaabi3849 you mean total bilirubin level? Did they do direct as well? If direct normal nothing to worry
Thank u sir I don't know is this direct or indirect level of bilirubin
Blood report shows 3.9 bilrubin level
Normal range 0.2 to 1.3
I am from srilanka
@@abinayaabi3849 it must be total. Why was it done
Dear Sir my daughter is 34 days old today. She is having jaundice till date. She responds well while breastfeeding, passes her stools twice or thrice a day. We are concern if it will cause problem to her. Please reply 😔
Have you done total and direct bilirubin recently? Is stool color normal
@@SridharKs yes we checked when she was 14 days old (it was 16.5mg) her stools yellow in colour
@@moasashinaga3207 it is most likely normal but it is better to do the above tests as discussed in the video
Hello sir , my baby had jaundice went up to 20 on her 18th day of her birth after phototherapy it went down 12 and still was 12 on her 25th day ! She still appears yellow when I press her palm or feet and legs. She has turned 1 month now should i be worried how long will it take to clear the yellowness ??
I presume the liver function has been done and the direct bilirubin is normal, and the stool colour is yellow? Is the baby fully breastfed?
@@SridharKs liver function is not done doctor said not req. direct bb is normal yes the stool color is yellow and fully breastfed baby. Other tests were done full CBC reactive tests everything normal.
When second tym she went for phototherapy then I stopped the breastfeed for 2 days but then I restarted it .and kept on breastfeeding
@@jssudha If direct bilirubin normal, this level of jaundice can persist even for a few weeks. I would suggest a full liver function test in 2 weeks, and if newborn screen or thyroid function not done, add a thyroid function to the same. Continue exclusive breastfeeding
@@jssudha It's good you continued breastfeeding. Don't worry, it should be okay
Sir,my baby bilirubin level was 14 at 6 day and 9.8 at 10 day and at 22 day its 9.6.
Baby is on breastmilk only one formula feed a day.
Stool is normal and 6/7stools a day and so wet diapers.
Do I need to go for phototherapy or any other treatment?local peadtrican suggested to wait for 15 more days to retest bilirubin level.
I hope you did direct bilirubin test as well. Total bilirubin that you mentioned is fine, and hope thyroid function is normal. If both not done, you could do total and direct bilirubin and free T4, TSH and if both normal, May not need any more repeat.
Thank you Doctor.
Please make a video in hindi also
I think you can get subtitles in Hindi
My newborn is 6weeks old. This is a 28days blood test results Bilirubin 9.5..direct 2.2 alkaline phospatese 879.6 urine and motion normal sir..now eyes Change white color ..but long press on skin sometimes normal skin..sometimes yellow skin sir.. Is it normal? Me and my baby also same blood group..we don't have thyroid..pls reply sir.what can I do sir?
The direct bilirubin is on higher side, so we need to repeat the tests next week to confirm trend
7-10 days from this test