A neurologic dysfunction scoring protocol for jaundiced neonates requiring exchange transfusion.
OBJECTIVE
To evaluate the performance of a neurologic assessment protocol among jaundiced infants requiring exchange transfusion (ET).


METHODS
We identified infants in a referral children's hospital who received ET and those who met the American Academy of Pediatrics (AAP) criteria for ET based on total serum bilirubin (TSB) levels. The performance of a bilirubin-induced neurologic dysfunction (BIND-M) scoring protocol for acute bilirubin encephalopathy (ABE) in detecting infants treated with ET in both groups was investigated by logistic regression analysis and c-statistic.


RESULTS
A total of 438 late-preterm and term infants were enrolled, out of which 141 (32.2%) received ET, and 155 (35.4%) met AAP criteria for ET. Infants with BIND-M scores of 3-6 (intermediate ABE) or 7-12 (advanced ABE) were significantly associated with ET in both groups, but not scores of 1-2 (mild ABE), with or without adjustment for confounding neurotoxicity risk factors. However, the discriminatory ability of BIND-M regression models was modestly satisfactory (c-statistic range: 0.693-0.791).


CONCLUSIONS
Our findings suggest that BIND-M is a potentially useful decision-making tool for ET and support current recommendation for immediate ET for infants with intermediate-to-advanced stages of ABE regardless of the TSB levels.
a Center for Healthy Start Initiative , Lagos , Nigeria.
Bolajoko O
BO
Olusanya
a Center for Healthy Start Initiative , Lagos , Nigeria.
Folashade B
FB
Osibanjo
b Massey Street Children's Hospital , Lagos , Nigeria.
Adeniyi A
AA
Ajiboye
b Massey Street Children's Hospital , Lagos , Nigeria.
Oluwafemi E
OE
Ayodele
b Massey Street Children's Hospital , Lagos , Nigeria.
Adebanke A
AA
Odunsi
b Massey Street Children's Hospital , Lagos , Nigeria.
Serah M
SM
Olaifa
b Massey Street Children's Hospital , Lagos , Nigeria.
Abieyuwa A
AA
Emokpae
D001663:Bilirubin / Q000097:blood; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D003661:Decision Support Techniques; D005078:Exchange Transfusion, Whole Blood / Q000706:statistics & numerical data; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007567:Jaundice, Neonatal / Q000097:blood / Q000175:diagnosis / Q000628:therapy*; D007647:Kernicterus / Q000097:blood*; D016015:Logistic Models; D008297:Male; D009549:Nigeria; D012720:Severity of Illness Index
D001663:Bilirubin
Acute bilirubin encephalopathy; exchange transfusion; late presentation; neurological examination; newborn care