title: Prediction of 3- to 5-Month Outcomes from Signs of Acute Bilirubin Toxicity in Newborn Infants.
abstract: 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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  The BIND score can be used to evaluate the severity of acute bilirubin encephalopathy and predict residual neurologic and hearing dysfunction.
authors.affiliation: Department of Pediatrics, Cairo University, Cairo, Egypt. Electronic address: salmelhouchi@yahoo.com.
authors.forename: Salma Z
authors.initials: SZ
authors.lastname: El Houchi
authors.affiliation: Department of Pediatrics, Cairo University, Cairo, Egypt.
authors.forename: Iman
authors.initials: I
authors.lastname: Iskander
authors.affiliation: Department of Pediatrics, Cairo University, Cairo, Egypt.
authors.forename: Rasha
authors.initials: R
authors.lastname: Gamaleldin
authors.affiliation: Department of Audiology, Cairo University, Cairo, Egypt.
authors.forename: Amira
authors.initials: A
authors.lastname: El Shenawy
authors.affiliation: Department of Pediatrics, Cairo University, Cairo, Egypt.
authors.forename: Iman
authors.initials: I
authors.lastname: Seoud
authors.affiliation: Clinical/Chemical Pathology, Cairo University, Cairo, Egypt.
authors.forename: Hazem
authors.initials: H
authors.lastname: Abou-Youssef
authors.affiliation: Department of Pediatrics, University of Washington, Seattle, WA.
authors.forename: Richard P
authors.initials: RP
authors.lastname: Wennberg
mesh_terms: D000208:Acute Disease; D001663:Bilirubin / Q000097:blood*; D015331:Cohort Studies; D002658:Developmental Disabilities / Q000453:epidemiology / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D007567:Jaundice, Neonatal / Q000175:diagnosis* / Q000453:epidemiology; D007647:Kernicterus / Q000175:diagnosis* / Q000453:epidemiology; 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
chemical_list: D001663:Bilirubin
keywords: BIND score; acute bilirubin encephalopathy; auditory neuropathy; automated auditory brain stem response; bilirubin induced neurologic dysfunction; chronic bilirubin encephalopathy; hyperbilirubinemia; kernicterus