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J Pediatr. 2017 Apr;183:51-55.e1. doi: 10.1016/j.jpeds.2016.12.079. Epub 2017 Jan 25.

Prediction of 3- to 5-Month Outcomes from Signs of Acute Bilirubin Toxicity in Newborn Infants.

Author information

1
Department of Pediatrics, Cairo University, Cairo, Egypt. Electronic address: salmelhouchi@yahoo.com.
2
Department of Pediatrics, Cairo University, Cairo, Egypt.
3
Department of Audiology, Cairo University, Cairo, Egypt.
4
Clinical/Chemical Pathology, Cairo University, Cairo, Egypt.
5
Department of Pediatrics, University of Washington, Seattle, WA.

Abstract

OBJECTIVE:

To evaluate the ability of the bilirubin-induced neurologic dysfunction (BIND) score to predict residual neurologic and auditory disability and to document the relationship of BIND score to total serum bilirubin (TSB) concentration.

STUDY DESIGN:

The BIND score (assessing mental status, muscle tone, and cry patterns) was obtained serially at 6- to 8-hour intervals in 220 near-term and full-term infants with severe hyperbilirubinemia. Neurologic and/or auditory outcomes at 3-5 months of age were correlated with the highest calculated BIND score. The BIND score was also correlated with TSB.

RESULTS:

Follow-up neurologic and auditory examinations were performed for 145/202 (72%) surviving infants. All infants with severe acute bilirubin encephalopathy (BIND scores 7-9) either died or suffered residual neurologic and auditory impairment. Of 24 cases with moderate encephalopathy (BIND 4-6), 15 (62.5%) resolved following aggressive intervention and were normal at follow-up. Three of 73 infants with mild encephalopathy (BIND scores 1-3) but severe jaundice (TSB ranging 33.5-38 mg/dL; 573-650 µmol/L) had residual neurologic and/or auditory impairment. A BIND score ≥4 had a specificity of 87.3% and a sensitivity of 97.4% for predicting poor neurologic outcomes (receiver operating characteristic analysis). BIND scores trended higher with severe hyperbilirubinemia (r2 = 0.54, P < .005), but 5/39 (13%) infants with TSB ≥36.5 mg/dL (624 µmol/L) had BIND scores ≤3, and normal outcomes at 3-5 months.

CONCLUSIONS:

The BIND score can be used to evaluate the severity of acute bilirubin encephalopathy and predict residual neurologic and hearing dysfunction.

KEYWORDS:

BIND score; acute bilirubin encephalopathy; auditory neuropathy; automated auditory brain stem response; bilirubin induced neurologic dysfunction; chronic bilirubin encephalopathy; hyperbilirubinemia; kernicterus

PMID:
28131490
DOI:
10.1016/j.jpeds.2016.12.079
[Indexed for MEDLINE]

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