Tcb Updates

Posted June 24, 2025 

New Jaundice Guidelines

We are currently working to update our Newborn Jaundice protocols to ensure that they follow the new CPS guidelines. However, this process will take some time and we want to give you some instruction on how to manage in the meantime.

We will now be asked to collect serum albumin in certain instances.  Albumin is a water-soluble protein that plays a significant role in neonatal jaundice by binding with bilirubin in the blood, thereby reducing free bilirubin levels that can cross the blood-brain barrier and potentially injure the brain.  Higher albumin levels have been shown to have a neuroprotective effect on the newborn brain.

Please follow these steps when you encounter the following situations:

•  If a MRP gives you a verbal order to collect an albumin along with the TSB, please fill the microtainer with the green top to the level of the writing or just above that (see photo). This will give enough of a sample to test for both albumin and TSB.

• If a TcB of ≥ 250 µmol/L is detected during our standard TcB screening protocol, please draw a TSB, albumin, and DAT (if it hasn’t been drawn already).

  

Thank you all for your patience and please do not hesitate to reach out with any feedback or questions that you may have as we navigate these changes to our Newborn Jaundice program.

Posted July 9, 2025

Please ensure that you are up to date with the Tcb protocols. 

•  Assess for discharge from the “jaundice screening program” if term infant (38 + weeks) and ≥ 48 hours of age; or preterm (35-37/6 weeks) and ≥ 96 hours.
•  If term infant and in TcB green zone, may discharge even if <48hrs if clinically well and no risk factors.
• If term infant and in TcB yellow or red zone and <48hrs, follow-up is needed.
• ALL preterm infants (35-37/6 weeks) require follow-up TcB until ≥96hrs regardless of TcB zone. 
• If term infant and in TcB yellow zone >48hrs – Routine care – discharge from jaundice screening program.

We have had several incidents recently where a family has requested that the nurse re test for jaundice after the baby has been discharged from the jaundice screening program.  This has led to additional visits and blood work that were unnecessary.  It is our job to educate the families and ensure that they understand that the baby’s yellow color is not the only factor in determining jaundice. The new CPS guidelines clearly state that ‘Hyperbilirubinemia is a common condition and is usually benign in term and late preterm newborns’.  It is a result of an immature liver.  Our focus should be on encouraging ‘protective measures like skin to skin contact, breastfeeding support and ensuring feeding effectiveness by monitoring the infant’s weight and urine and stool outputs’.  

Our protocols are firmly rooted in the physiology of jaundice. While your clinical judgement at the time of assessment will be supported, please consider the whole picture.  If you are considering stepping outside of the protocol, please consult with the Supervisor, Team Leader or family physician first.

Posted October 1, 2025

Newborn Hyperbilirubinemia Program Update

Thank you to everyone for your patience as we roll out the changes to the  newborn jaundice program.  Your feedback is so valuable.  You are the ones who work with these documents and follow this work flow daily.  Please let Kerry or Nicole know if you have questions or suggestions on how we can continue to integrate the necessary changes in the best way possible to facilitate your work.  

You will now find the Newborn Hyperbilirubinemia Record in the all the client charts starting today. This will replace our old Transcutaneous Bilirubin (TcB) nomogram. If your chart does not have the new record, please put it in the chart and use the updated documents from now on. 

It is important to note that the hyperbili.com tool is a universal tool that was developed to be used in centers without access to transcutaneous bilirubin screening. In those centers, TSB values will guide practice.  At Healthy and Home, our practice has not changed; TcB monitoring always precedes TSB collection. TSB is only necessary if indicated by the TSB screening guidelines.

The new record will clarify discharge guidelines:                                         
Discharge guidelines: 
Preterm (<38 weeks), ≥96 hrs & ΔTSB 61-89, may discharge from jaundice monitoring program.

Term (≥38 weeks), ≥48 hrs & ΔTSB  61-89, may discharge from jaundice monitoring program. 

Post phototherapy, hyperbili.com will not calculate the ∆TSB nor will it give a recommendation for follow up. You will need to manually calculate the ΔTSB for those babies. Remember we CAN now monitor with TcB if > 18 hours post phototherapy.  Once you enter the TcB value and the birth date into hyperbili.com, it will calculate the phototherapy threshold for you.                                                                  

ΔTSB = Phototherapy threshold – Measured TcB

We will also move to implementing the new language on the white cards.  Because JPCH has not implemented the new guidelines, when a chart is triaged, we will still note the jaundice level by color in the bottom right of the white card.  When sending your update to the Team Lead,  please report the delta value (∆) she will then replace the color on the white card with the delta value.  There is a large font laminated card on the white board for easy reference as we learn and implement the new language.  

All the iphones now have the greek alphabet keyboard installed to make this easier.  When you wan to insert the ∆ press the globe symbol in the bottom left corner below the keyboard. Press the ∆ and then the globe again to return to the regular keyboard.  

Posted October 8, 2025

Tcb News

As was expected, when a new tool is put to use, there are some kinks to work out.  The staff feedback has been very good.  Thank you for your feedback and for the ways that you help each other problem solve.  I'm always so proud of how the team bands together to embrace new initiatives! 💖

 

Here are some of the things that have been discussion points this week:

1.  There were some questions about discharging babies whose ∆ falls between 61 - 89 after a serum collection.  Although the discharge guidelines were not printed in the box on the TSB table, they still apply to the serum values the same as with the Tcb values.  On the next print out of the record, we will include the guidelines on both tables.  

2. We have discovered that you don't get a ∆ value if your Tcb is high enough to warrant a serum collection.  We thought this only happened if babe had phototherapy.  We have since discovered that is not the case. Its ok, we don't need the ∆ in this instance.  Collect the serum. (Remember, if the Tcb reading is within 50 µmol of the phototherapy threshold, it will prompt a serum collection.) 

If the Tcb value indicates a serum collection is warranted, and the reading is >250, collect an Albumin (if one has not yet been collected), a DAT (prn) and a TSB.  When you enter the TSB value into hyperbili.com it will give you a ∆ value➡️  consult the TSB table.  

3. Please remember that DAT + is a risk for neurotoxicity.  That requires a 'yes' answer the 1st question on the initial page of hyperbili.com.  Last week we had 3 DAT+ babies discharged from JPCH in the red zone.  2 of them were over phototherapy threshold prior to discharge.  I don't think the DAT + element was factored in.  We re admitted all three babies for phototherapy.  A safety report was filed. 

Posted on October 15, 2025

Newborn Hyperbilirubinemia Update:

Thank you for your continued feedback as we implement the new guidelines!

1. To decrease confusion when charting our ΔTSB values, we have made more edits to the Newborn Hyperbilirubinemia Record. The record is now divided into two sections.

The section on the left is for TcB screenings and resulting ΔTSB.

The section on the right is for TSB screenings and resulting ΔTSB.

You only have one ΔTSB to report at each home visit. 

2. There was a great point brought up this week regarding albumin and neurotoxicity risk factors. 

Scenario:      

• Baby born at 38+2 weeks
•  No initial neurotoxicity risk factors
• TcB at 83 hrs old was ≥250 µmol/L
• TSB, albumin & DAT were drawn
• Albumin was 28 g/L & DAT was negative 

If a baby’s serum albumin is < 30 g/L it is considered hypoalbuminemia and this is a neurotoxicity risk factor. For all future TcB screenings, the baby will have a neurotoxicity risk factor, and this must be entered in the hyperbili.com tool. 

You will find a new line on our Newborn Hyperbilirubinemia Record. Beside where the DAT and albumin results are documented, you will see a section that states: 
Neurotoxicity risk factors? Y/N.  This should serve as a helpful way of alerting us to neurotoxicity risk factors when they become present.

Remember:

·         Higher albumin levels = neuroprotective
·         Lower albumin levels = neurotoxic