WILTIMS #359-360: Shiny toys

Today started out pretty mild and boring in the nursery.  One of the babies I had been following was discharged yesterday. There were no new babies overnight and no scheduled C-sections for the day. But after a couple hours, a couple really interesting things happened all at once.

The first was that one of our babies routine labs came back with an alarmingly high bilirubin level and, relatedly, he developed pretty severe jaundice overnight. Bilirubin is one of the breakdown products of blood cells and is normally detoxified by the liver. The baby liver, however, is not up to the job yet during the first few weeks of life, so if anything causes more red blood cells to be recycled than normal, the bilirubin level will rise. Bilirubin's further breakdown products are what are responsible for the brown color of stool and the yellow color of urine. When bilirubin can't be converted to these products by the liver, it builds up in the blood and turns the skin yellow - a condition called jaundice.

On the left is the unit before all the lights are turned on. Above,

the blue glow from above and the green blanket in the center.

Many babies develop mild jaundice, but if the bilirubin level becomes dangerous, the treatment is phototherapy. For once, I think all of you should be able to translate that bit of jargon. The light that we use is not the sun, but a super cool looking blue and green box of medical awesomeness. Two high-intensity blue lights are placed above the nearly naked baby in a NICU baby pod to help breakdown all that excess bilirubin. What about the baby's back, you ask? They have a fiberoptics-powered light-emitting blanket that glows green under the sleeping baby. The last piece is a tiny eye-cover to keep the baby's eyes safe from the lights.

Speaking of cool medical devices, this was the first week that I got to see the video translator service in use. There is an iPad on a rolling stand that can be wheeled into a patient's room and connected to an off-sight professional translator who essentially Skypes into the room to bridge the language gap between the care team and the patient. There is an impressive selection of languages available, though the rarer ones are only available during normal business hours. Of course, over 200 languages are available 24/7 by plain old phone.

The other interesting thing today was the unscheduled delivery of a baby with a cleft lip. This is a congenital condition where two of the pieces of the upper lip don't fully merge during development. The more severe version extends backward to the palate. Though we are all taught extensively about these malformations, even the pediatric residents I was working under hadn't seen one of these in real life. A little plastic surgery next week and you'd be hard pressed to notice that this kid had anything wrong with him for the rest of his life.

YesterdayIL: Whereas high blood pressure is defined by specific pressures for adults, hypertension is adjusted according to sex, age, and height for children. Then for each group, children with blood pressure less than the 90th percentile are considered normal. 90-95 is prehypertension, 95-99 is stage 1, and >99 is stage 2.

TIL: Phototherapy is not actually done with UV light, which makes a ton of sense. Two visible wavelengths of light have been found to efficiently break down bilirubin through the skin, one blue and one green.