When Hyperbilirubinemia Isn't Physiologic - A Modern Day Screening Approach

F. Tania Mitsinikos, MD, F AAP,  Clinical Fellow, PGY-6 -  Division of Gastroenterology, Hepatology, and Nutrition ,  Children's Hospital Los Angeles.

Daniel Thomas, MD, FAAP - Director, Hepatology, Medical Director of Liver and Intestinal Transplant, Division of Gastroenterology, Hepatology and Nutrition,  Children's Hospital Los Angeles.

F. Tania Mitsinikos, MD, F AAP

Every pediatrician is well trained to screen and identify     

Daniel Thomas, MD, FAAP

neonates with hyperbilirubinemia. The American Academy of Pediatrics (AAP) has established guidelines for screening and management of neonates with hyperbilirubinemia ¹ . Fortunately, the incidence of kernicterus, caused by unconjugated hyperbilirubinemia, has declined over the years and is estimated to be near 1 in 100,000, but is largely unknown due to lack of definitive epidemiologic studies, particularly in the United States ^2,3 .  Risk factors for hyperbilirubinemia leading to neurotoxicity include: Isoimmune hemolytic disease, G6PD deficiency, asphyxia, sepsis, acidosis, and albumin <3.0 mg/dL, which differ somewhat from the risk factors for severe hyperbilirubinemia ⁴ . However, there is a larger group of neonates with conjugated hyperbilirubinemia that need our heightened attention due to long-term morbidity and mortality, which is only briefly touched upon in the AAP recommendations. Read full article...

 

On Monday, April 24th, I returned to Sacramento to represent the American Academy of Pediatrics, CA in front of the Senate Business, Professions and Economic Development Committee. On that day, I spoke in opposition to two bills: SB 392 Bates, SB 501 Glazer, and in favor of one: SB 794 Stern.

 

SB 392 Bates would call for a study to determine the effects on access to care before implementing the recommendations of the CA Dental Board requiring an end to the single operator-anesthetist model for children under 7 yo in dental settings. We stand in opposition to this bill as it does not put a child's safety first. Current data shows that there are 9,300 anesthesia providers in the state of CA who could provide the necessary additional services.

 

	Senator Henry Stern with Dr. Whiteman at the State Capitol in Sacramento.

SB 501 Glazer disregards and omits the most important recommendation of the CA Dental Board relative to pediatric anesthesia use, which is the elimination of the use of the single operator-anesthetist model for deep sedation and/or general anesthesia for children under age 7 yo.

 

SB 794 Stern is a bill focusing on the labeling and packaging of marijuana edibles, now that marijuana is legal. Some of the bill highlights with regards to marijuana edibles include: that the packing design not be appealing to children or easily confused with commercially sold candy or foods that do not contain marijuana; that the marijuana edible be scored by standardized serving size not to exceed ten (10) milligrams tetrahydrocannabinol (THC); that the marijuana edible be sold in packaging that is both tamperproof and child resistant, and, if the marijuana edible contains more than one serving, that the packaging be resealable. Senator Stern represents Senate District 27, which falls within our Chapter boundaries.

 

AAP-CA is in support of SB 794. This bill is also consistent with the intent of my number one resolution from the 2014 ALF, which focused on marijuana advertising that could be perceived as directed towards children.

PROS UPDATE

Heide Woo, MD, FAAP and David Feazell, MD, FAAP -  PROS Chapter Coordinators

 

PROS had a wonderful and energizing Spring Meeting in Chicago.

 

PROS, Pediatric Research in Office Settings, is currently recruiting for a NEW STUDY! 

 

Flu2Text

Within each practice, half the enrolled parents will serve as the control and will not receive the study text message reminders but the practice will continue with usual practice.

 

PROS is also recruiting for new members, and encouraging all current members, to sign up and join PROS BRIEF.  Brief Response to Improv E the Field.  PROS BRIEF will be a twice per year survey on topics relevant to current or pending studies as well as to issues of interest to the practicing pediatrician.  The survey will be short and have a quick turn around for results and feedback to the participating practitioners.  There is also be an opportunity to discuss the results and make comments or raise related topics in a process of "deBRIEFing".  For those already in PROS, look for the invitation postcard in the mail, and for those who are not yet in PROS, but are interested in joining, contact PROS to sign up!  And invite your friends and colleagues to join as well!

 

Two studies will be recruiting soon:  BMI2+ and STOP-HPV, both based on use of EMR.

 

Do you have PCC EMR?  Are you interested in prevention and treatment of childhood overweight and obesity?  If so, BMI2+ will be recruiting soon.  In order to join as soon as recruitment starts, join PROS now and let us know that you are interested the BMI2+ study.  Those who participate in the study will get expert MI training taught by one of the world's experts on motivational interviewing.  In addition, participants in the intervention arm will also get MOC4 credit for all their efforts.

 

 

PROS has 2 studies currently active:  DART, an antibiotic prescribing and parent communication study, and HEMPP, an adolescent marijuana counseling study. 

 

Other studies are awaiting funding or in development. 

 

To join PROS or get more information, please feel free to contact us at hwoo@mednet.ucla.edu or dfeazell@mednet.ucla.edu  or visit www.aap.org and search under PROS, or email the AAP PROS staff at PROSops@aap.org .