Prediction of 3- to 5-Month Outcomes from Signs of Acute Bilirubin Toxicity in Newborn Infants - 18/04/17
, Iman Iskander, MD 1, *, Rasha Gamaleldin, MD 1, Amira El Shenawy, MD 2, Iman Seoud, MD 1, Hazem Abou-Youssef, MD 3, Richard P. Wennberg, MD 4Abstract |
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.
Le texte complet de cet article est disponible en PDF.Keywords : hyperbilirubinemia, kernicterus, acute bilirubin encephalopathy, chronic bilirubin encephalopathy, auditory neuropathy, bilirubin induced neurologic dysfunction, BIND score, automated auditory brain stem response
Abbreviations : AABR, ABE, BIND, CBE, TSB
Plan
| Supported by National Institutes of Health/Eunice Kennedy Shriver National Institute of Child Health and Human Development (R21HD060901), the American Recovery and Reinvestment Act of 2009, and National Center for Research Resources/National Institutes of Health (UL1 RR025014 [to R.W.]). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The authors declare no conflicts of interest. |
Vol 183
P. 51 - avril 2017 Retour au numéro
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