Characteristics and outcome of newborn admitted with acute bilirubin encephalopathy to a tertiary neonatal intensive care unit

World J Pediatr. 2019 Feb;15(1):42-48. doi: 10.1007/s12519-018-0200-4. Epub 2018 Nov 7.

Abstract

Background: Acute bilirubin encephalopathy (ABE) still represents a significant cause of morbidity and mortality throughout the world, especially in developing countries. We aimed to determine the prevalence of ABE based on the Johnson bilirubin-induced neurologic dysfunction (BIND) score and to describe the discharge outcomes.

Methods: We prospectively studied all newborns ≥ 35 weeks with ABE by evaluating signs of mental sensorium, muscle tone, and cry patterns over 1 year.

Results: 12% (81 out of 674) of the newborns admitted for neonatal hyperbilirubinemia had a BIND score > 1. Their admission age was 6 ± 4.1 days; total serum bilirubin (TSB) was 31.2 ± 10 mg/dL (range 17.5-75.2). Of these newborns, 40.7% and 21% had evidence of haemolysis and sepsis, respectively. Overall mortality was 9.9%; 58% of the newborns showed signs of mild-to-moderate BIND at discharge, while 32.1% survived with an apparently normal outcome. Admission BIND score was significantly correlated with admission TSB (r = 0.476, P < 0.001). Similarly, BIND score at discharge was correlated with admission TSB (r = 0.442, P < 0.001) and admission BIND score (r = 0.888, P < 0.001). The regression model showed that admission TSB (P < 0.001) and maternal illiteracy (P = 0.034) were predictors of the BIND score at admission, while admission BIND score was the best indicator of the discharge score (P < 0.001).

Conclusions: ABE is still a major problem in our community. Admission TSB and maternal illiteracy are good predictors of bilirubin encephalopathy at admission and discharge.

Keywords: Bilirubin encephalopathy; Bilirubin-induced neurologic dysfunction; Kernicterus; Neonatal hyperbilirubinemia.

Publication types

  • Observational Study

MeSH terms

  • Bilirubin / blood
  • Egypt / epidemiology
  • Female
  • Hemolysis
  • Hospital Mortality
  • Humans
  • Hyperbilirubinemia, Neonatal / epidemiology*
  • Infant, Newborn
  • Intensive Care Units, Neonatal*
  • Kernicterus / epidemiology*
  • Literacy
  • Male
  • Mothers
  • Neurodevelopmental Disorders / epidemiology
  • Neurodevelopmental Disorders / etiology
  • Prospective Studies
  • Sepsis / epidemiology
  • Severity of Illness Index
  • Tertiary Care Centers

Substances

  • Bilirubin