Grand Rounds: Why do we check direct bilirubin in newborns?

Objectives (Educational Content) :

1. Explain the role of direct bilirubin measurement in detecting cholestasis and its implications in identifying early signs of biliary atresia in newborns. 2. Discuss the appropriate timing to check direct bilirubin levels in newborns to maximize early detection of biliary atresia. 3. Outline key factors influencing the prognosis of biliary atresia, such as timing of diagnosis, timing of Kasai portoenterostomy, and timing of liver transplant.

Target Audience:

General pediatricians, family physicians, nurse practitioners, physician assistants, social workers, psychologists, and nurses.

Identified Gap:

Direct bilirubinemia in infancy needs to be checked and addressed early to rule out and manage biliary atresia to decrease morbidity and provide early interventional options for these patients.

Estimated Time to Complete the Educational Activity:

1 hour(s)

Expiration Date for CE/CME Credit:

01-14-2026

Method of Participation in the Learning Process:

The learner will view the presentation, successfully complete a post-test and complete an activity evaluation.

Evaluation Methods:

All learners must successfully complete a post-test, as well as an activity evaluation, to claim CE/CME credit.

Disclosure:

The following presenter has indicated that a financial relationship with an ineligible company: Ultragenyx, Moderna, Mirum, Ipsen, Sanofi, Gilead, The Peter and Tommy Colucci Research Fund. Akihiro Asai, MD. The following planning committee member has indicated that a financial relationship with an ineligible company: All relationships have been mitigated. The remaining planning committee/CME committee members have indicated that they have no financial relationships with any ineligible companies.

Accreditation Statement:

Children’s Hospital Medical Center of Akron is accredited by the Ohio State Medical Association to provide continuing medical education for physicians.

CHMCA designates this enduring material activity for a maximum of 1.0 AMA PRA Category 1 Credit TM.  Physicians should only claim the credit commensurate with the extent of their participation in the activity.

Bibliography:

1. Harpavat S, Garcia-Prats JA, Shneider BL. NEJM. 2016;375(6):605-606

2. Arshad et al., Arch Dis Child, 2023, 108

3. Tyraskis, A., Davenport, M. Steroids after the Kasai procedure for biliary atresia: the effect of age at Kasai portoenterostomy. Pediatr Surg Int 32, 193–200 (2016). https://doi.org/10.1007/s00383-015-3836-3