Prediction of 3- to 5-Month Outcomes from Signs of Acute Bilirubin Toxicity in Newborn Infants.
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.
['El Houchi|Salma Z|SZ|', 'Iskander|Iman|I|', 'Gamaleldin|Rasha|R|', 'El Shenawy|Amira|A|', 'Seoud|Iman|I|', 'Abou-Youssef|Hazem|H|', 'Wennberg|Richard P|RP|']
D000208:Acute Disease D001663:Bilirubin D015331:Cohort Studies D002658:Developmental Disabilities D005260:Female D005500:Follow-Up Studies D005865:Gestational Age D006801:Humans D015994:Incidence D007223:Infant D007231:Infant, Newborn D007234:Infant, Premature D007567:Jaundice, Neonatal D007647:Kernicterus D008297:Male D009460:Neurologic Examination D011237:Predictive Value of Tests D012372:ROC Curve D012189:Retrospective Studies D018570:Risk Assessment D012680:Sensitivity and Specificity D012720:Severity of Illness Index D013997:Time Factors
BIND score hyperbilirubinemia acute bilirubin encephalopathy auditory neuropathy automated auditory brain stem response bilirubin induced neurologic dysfunction chronic bilirubin encephalopathy kernicterus