Can someone dumb down The whole TCB thing?

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I understand the basics of bilirubin/jaundice. What I do not understand is why we have to check TCB after 24 hours, why not before? I thought physiological jaundice was jaundice that developed after 24 hrs and pathological jaundice develops prior to 24 hours. So why do we do the 24 hour check and day of discharge check?

I also don't understand the chart they give us to know whether the level is too high or too low. I understand that some babies have high, low or intermediate risk factors, but the chart does not clearly explain what normal versus abnormal is.

Does anyone have any advice or tips on this? Any algorithm for TCB that is clear and understandable ? I've tried to google this but didn't come up with much. Thanks in advance for your help.

OAN: I'm in love with my new job as a postpartum nurse. Monday is my first day off orientation. Wish me luck!

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Specializes in MICU/Postpartum.
I understand the basics of bilirubin/jaundice. What I do not understand is why we have to check TCB after 24 hours, why not before? I thought physiological jaundice was jaundice that developed after 24 hrs and pathological jaundice develops prior to 24 hours. So why do we do the 24 hour check and day of discharge check?

I also don't understand the chart they give us to know whether the level is too high or too low. I understand that some babies have high, low or intermediate risk factors, but the chart does not clearly explain what normal versus abnormal is.

Does anyone have any advice or tips on this? Any algorithm for TCB that is clear and understandable ? I've tried to google this but didn't come up with much. Thanks in advance for your help.

OAN: I'm in love with my new job as a postpartum nurse. Monday is my first day off orientation. Wish me luck!

From what I understand, TCB or serum bili's are not done before 24 hours (pathological) if the baby doesn't have risk factors such as prematurity, ABO incompatibility, breastfeeding etc. For example any baby with a positive Coombs result gets a 6 hour serum drawn. Sometimes if I have an exclusively breast feeding mom who doesn't seem to feed quite well, I do TCBs on their babies before 24 if they look a little jaundiced. Physiological jaundice usually peaks between 1-4 days that's why that TCB check is done. At my institution our TCB chart is rather simple and broken down from 1hr to about 72 hours with mg/dl numbers that range from 6-12.9 mg/dl along with protocols on whether baby follows up with their normal Ped in 1-3 days, serums to be drawn or whether the physician should be notified immediately. Regardless of hours of age, any TCB over 13mg/dL requires us to follow up with a serum and a call to the physician when the results are back.

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Google Bilitool ... love it... :)

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Thanks you both! very helpful

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Specializes in OB (with a history of cardiac).

Yeah we use the bilitool, and it's pretty self explanatory with the chart. I find that often times the longer out I wait to do TCB (closer to the 32 hour mark) the lower the risk. We will do a serum bili right away if mom is RH negative and baby is RH positive and DAT positive. Often we'll do a TCB sooner than 24 if baby looks ruddy or jaundiced and mom is RH neg, regardless of baby's ABORH.

I was wondering if anyone else had heard anything about the connection between mom being O positive and a higher likelihood of baby becoming jaundiced. Is this common knowledge? (Apparently it is on our unit, but I haven't really gotten a reason why).

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If mom is o positive she has anti a and b antigens which can make the baby susceptible to abo incompatibility . Which can cause hemolytic anemia which causes jaundice .....

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