I’m 11 and really wanting to be a neonatologist when I grow up so I am getting a head start on it now. Let me just say that usually when I’m studying jaundice or anemia or ect. I get very confused. I am sooo grateful for this video and how it explains things. This was great. Tysm 😅 It really helped with my studies! ❤
Mary! That is amazing!! 11! Definitely our youngest viewer (apart from when we've forced our kids to watch! ha!) We are SO impressed you are watching any medical videos let alone about jaundice!!! We think it is the BEST field in the world-so I think you're making a great decision. The babies will be so lucky to have you take care of them! We wish you luck and perseverance :)
4:25 RBCs when it breaks down it will not release Bilirubin as you said; it will release Hemoglobin which then Macrophages line cells will pick up and start breaking it down to Heme and Globins. Heme is then further broken down to Iron and Bilivirdin; Bilivirdin then will be converted to Bilirubin by these cells, and the story does not end there
Hello! Again- you're absolutely right. We missed out many, many steps in the bilirubin metabolism, and even more with what happens in the gut with bilirubin. So even though those steps are important for exams, research, future meds etc- clinically they're not as relevant. And here we're really trying to emphasize what needs to be known for better bedside care!
Fun. Passionate. And greatly helpful! THANK YOU so much Dr. Tala for these amazing Videos. Would you please give a talk on fluid, nutrition, and growth? Thank you:)
Do I „freeze“ the gestational age at birth or do I let it mature postnatally when calculating fototherapy threshol? I mean: if a baby is born at 34+6 days and is now 9 days old and has jaundice, do I use the fototherapy theeshold for 34 gestational age or the one for 36 weeks, since the baby has technically reached that age outside the womb?
Great question- we still use gestational age at birth (otherwise counting the '9' days old twice). I thin we should do an updated hyperbili video with the guidelines that came out since we made the initial series of videos. Thanks so much for being here Christoph!
Albumin is apparently a genius molecule! I'm reading up on this but apparently it has different binding areas it can bind water soluble and fat soluble molecules. (Thanks for the question- I wasn't sure!)
Does the lab value for indirect bilirubin include the bound indirect bilirubin? Bound bilirubin is not conjugated, correct? So is there a way to account for how much bound indirect bilirubin there is? Or does that not matter because it is bound and so not a threat?
This is such a great question Elizabeth. Nearly every lab counts the total bilirubin (includes conjugated=direct, as well as unconjugated=indirect- everything that is bound and free). We don't have easy consistent ways to measure the free, unconjugated (indirect) bilirubin. As you said, this is what we really care about. So we have to make conclusions and guesses based on other values. So if the direct bilirubin is high- we are more concerned. (Not because it crosses the BBB, but because it will displace unconjugated bilirubin from albumin and increase how much free bilirubin there is). If the albumin is low, we are also more worried about how much free bilirubin there will be. Honestly though- even if we knew the exact number for 'free indirect bilirubin'- it still wouldn't give the full story. Each infant's BBB (blood brain barrier) would be different from others. If an infant is premature or has sepsis, they would have a weaker BBB, and so it would be more likely free bilirubin would get through. Does this all make sense??
Hello again! Yes! That is definitely high up on our list. Electrolytes/ fluids/ TPN is such a massive topic that we have been a little hesitant to start! We promise we'll get there!
Thanks for the video! I have a question about interpreting lab values - we send them blood and they send us back three numbers, the total, indirect, and direct bilirubin. Does the indirect bilirubin value include only unbound bilirubin molecules, or is it a sum of the unbound and albumin-bound? For example, if the albumin is low, does that mean that a given high indirect bili is more alarming (i.e., more unbound and able to cross into brain) than the same number would be if the albumin was normal?
Hello Marion! This is SUCH a great question and I wish I'd covered it better in the video! The indirect value includes both the bound and unbound values. So you're right- when the albumin is low we should be a lot more worried. (Especially since albumin is often low in setting of 'leaky' capillaries scenarios like in sepsis- which in itself would mean the blood brain barrier isn't as strong so same level of indirect bilirubin more likely to get into brain). There has been ongoing research to try to find a commercially available lab value that will only measure the unbound fraction.... Hope this helps! Thanks again for being here :)
Thanks u so much Doctor Tala. This video helped me understand 100 percent the difference between direct and indirect bilirubin. I love your videos and I love the way you teach.
That's so kind of you- thank you for advertising for us!!! ha! We're SO happy that these are helpful to you. It also all takes a lot more time than we had initially thought these videos would (ha!) and so I can't even tell you how motivating comments like yours are. They really keep us going! Thanks again for watching :)
Thank you so much for letting us know, Sam. To explain everything from the basics is really why we started this channel- so your comment was very validating! Thank you!
That's SO great!! We love your comments. I think teaching, like everything else, is mostly a skill. The more we do, the better we are. But I agree, I've definitely had a few teachers that I'm like- I want to present the information more like her or him!
When RBCs breakdown, bilirubin is released. (So a very elevated indirect bilirubin could imply that many RBCs have broken down and the patient is anemic. If the patient is anemic this could affect the body's oxygenation). Hope this helps??
@@TalaTalksNICU As a new NICU nurse (coming from adult ED and oncology), your vids are critical to my personal learning! I cannot thank you enough for your depth and enthusiastic presentation!
