Dr. Phil: "jaundice can cause brain damage"

[tofurious]

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The great Dr. Phil said the above after hearing a newborn had jaundice 3 days after birth...

Isn't he a psychiatrist? Didn't he have to go through peds?

 

[jaydee2004]

I think that he has a PhD, not an MD.

 

[rastelli]

He's a psychologist, not a psychiatrist.

Phil is correct however. Severe and prolonged jaundice does cause "brain damage"....it's called kernicterus. Bilirubin stains the basal ganglia...it's devastating. We've seen lots of kids from Central America who's mother didn't receive Rhogam with previous pregnancies and now these kids are a neurologic mess.

 

[BPKurtz]

Phil is correct however. Severe and prolonged jaundice does cause "brain damage"....it's called kernicterus. Bilirubin stains the basal ganglia...it's devastating.

When I spent time in the NICU as a student, they had a little matrix so you could figure out what levels of bilirubin were tolerable in a baby of a given prematurity and weight, on a given day of life. If it was too high you used bili lights or bili blankets -- certain wavelengths of light help conjugate the bilirubin. If it was severe you'd do an exchange transfusion although I haven't seen that done. The relatively low levels of bilirubin that cause normal neonatal jaundice don't approach the high levels necessary for kernicterus.

bpkurtz

 

[rastelli]

Hey Kurtz...you didn't train at Tulane did you? I was one of your favorite med. students...hope all is well.

 

[tkim]

He's a psychologist, not a psychiatrist.

Phil is correct however. Severe and prolonged jaundice does cause "brain damage"....it's called kernicterus. Bilirubin stains the basal ganglia...it's devastating. We've seen lots of kids from Central America who's mother didn't receive Rhogam with previous pregnancies and now these kids are a neurologic mess.

Isn't jaundice an external sign for increased bilirubin levels, and it is the bilirubin, not the jaundice, which is the actual cause of kernicterus?

Sorry to get pedantic, but the way it was phrased by Dr. Phil, I don't think would be correct.

EDIT: Hmmm, I guess 'jaundice' and elevated bilirubin levels are used interchangeably. Nevermind.

 

[BPKurtz]

Hey Kurtz...you didn't train at Tulane did you? I was one of your favorite med. students...hope all is well.

Nope, not Tulane -- Ohio State. Now I'm in DC.

bpkurtz

 

[tofurious]

The relatively low levels of bilirubin that cause normal neonatal jaundice don't approach the high levels necessary for kernicterus.
bpkurtz

I assumed that most people reading this forum would catch onto the neonatal jaundice right away. Perhaps there are too many 2nd year med students here...

 

[jakstat33]

pedantic? i'm going to have to dictionary.com that one! (reminds me of the darn verbal reasoning section of the mcat... bad times!) lol

OK, first i'll take a guess than look it up and see how close i was.... pedantic: nit-picky, anal, myopic, judicious.... OK now let's see how close i was

here it is:
pedantic, adj.
Characterized by a narrow, often ostentatious concern for book learning and formal rules: a pedantic attention to details.

excuse me for a moment while i complete another blackwell block, 8 year olds and champage, DISCUSS (what ever happened to coffee talk?)

Isn't jaundice an external sign for increased bilirubin levels, and it is the bilirubin, not the jaundice, which is the actual cause of kernicterus?

Sorry to get pedantic, but the way it was phrased by Dr. Phil, I don't think would be correct.

EDIT: Hmmm, I guess 'jaundice' and elevated bilirubin levels are used interchangeably. Nevermind.

 

[tkim]

Okay, I get the hint. I'm gone.

 

[BPKurtz]

I assumed that most people reading this forum would catch onto the neonatal jaundice right away. Perhaps there are too many 2nd year med students here...

I think what you're saying is that for Dr. Phil to bring up brain damage when someone mentions jaundice in a neonate is being unnecessarily alarmist, and you're right. Like telling someone with a headache they may have a brain tumor. I can't really see a newborn nursery, pediatrician, or family practice doc missing severe hyperbilirubinemia by not checking a level and just sending the kid home. What was the context of Dr. Phil's statement? Was he trying to blame some behavioral/cognitive problem on brain damage from neonatal hyperbilirubinemia? That would be quite a stretch. Or was he just suggesting that the parents of a jaundiced kid take him to a pediatrician to get him looked at?

bpkurtz

 

[Medikit]

I'm a premed, I just wanted to say that I enjoyed this thread

 

[labangel]

My problem with Dr. Phil is that most people believe that he is an MD, when in fact he has a Ph.D. and he doesn't do anything to dispel this....I have issues with some of his shows when he presents himself as giving medical advice. I saw the episode mentioned, it was about a dad who didn't like to take his kid to the doctor, even when his wife thought the baby was really sick. Apparently the baby looked jaundiced to the mom, but the dad didn't want to take the kid to a pediatrician. Dr. Phil was trying to say it's better to be safe than sorry, but he didn't phrase his point that well.

 

[Bernardo_11]

Saying that jaundice leads to brain damage is like saying all headaches mean brain tumors.

Jaundice is one of the most commonly seen newborn manifestations in pediatrics. All baby's have to go through some sort of blood cell breakdown at birth (their hematocrits in utero are higher than usual). And transient (ie physiologic) hyperbilirubinemia is the result. Sometimes it's worse than others. The causes are vast which range from infection, to breastFEEDING or breastMILK (there is a difference between the two in etiologies), and of course hemolysis.

The etiology that worries us pediatricians the most are high bilis related to some sort of hemolytic disease. Rh or ABO incompatibility, G6PD deficiency, and sometimes sepsis. Why? Because it's usually this hemolytic component that is most associated with kernicterus.

It used to baffle me in internship when babies came in with bilirubins as high as 24 (normal is 12) and some neonatologists were relaxed about it. Whereas the babies with a high retic count, low H/H, and bilirubins around 18 would be monitored much closely in anticipation for an exchange transfusion. Mind you, any sort of high bilirubin deserves a work-up and thus should never be taken lightly.

Classically we think that the bilirubin itself crosses the brain narrier and causes cellular injury. But some attendings I've spoken with feel the culprit is some component of the hemolytic process that is causing this damage-- the patholigic findings of bile in the brain cells could be merely incidental.

Either which way, you can see that Dr. Phil's comments are way too blanketing to be taken seriously. But then again... it's people like him, as well as old mother in laws, that make pediatrics consist of 90% in educating parents. 😀

Nardo 😛