CORROBORATION OF BILIRUBIN INDUCED NEUROLOGICAL DYSFUNCTION (BIND) SCORING CRITERIA AMONG HYPERBILIRUBINEMIA NEONATES - A PROSPECTIVE COHORT STUDY
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Keywords
Bilirubin Induced Neurological Dysfunction, Acute bilirubin encephalopathy, Neonatal Jaundice, Automated auditory brainstem response
Abstract
Background: Untreated unconjugated hyperbilirubinemia is potentially neurotoxic characterized by bilirubin induced neurological dysfunction (BIND), kernicterus and subsequently chorio-athetoid cerebral palsy. BIND scoring criteria is not adopted as standard for hyperbilirubinemia neonates’ assessment in most NICUs’ till date.
Aims: To determine Incidence of BIND and to assess the correlation of risk factors for BIND in neonates with hyperbilirubinemia.
Methods: This prospective observational study was conducted in Level III A NICU of BLDE (DU) Shri B M Patil Medical College Hospital and Research Center from January 2020 to December 2021. Inclusion Criteria: All neonates with gestational age >35 weeks presenting with hyperbilirubinemia were enrolled. Serum Bilirubin level estimation was done if neonate was icteric on clinical examination. BIND scoring was assessed in all neonates with significant hyperbilirubinemia as per AAP guidelines. In all BIND positive babies AABR was performed.
Results – Out of 173 neonates enrolled into the study, 80(46.2%) were females and 93 (53.8%) were males. The Mean age at admission was 70.3 ± 31 hours. The mean birth weight was 2665.8 grams ±268.6 grams and mean weight at admission was 2183.1 grams ±259. 125 (72.3%) neonates were term and 48 (27.7%) neonates were preterm. ABO incompatibility (38%) was most common maternal risk factor. Inadequate breast feeding (64.7%) was most common neonatal risk factor. History of previous sibling receiving phototherapy was 22 (12.7%). Mean duration of history of jaundice 10.4 hours± 7.9 hours. Mean total bilirubin was 14.1mg/dl ± 3.2 mg/dl with maximum being 27mg/dl. Mean BIND score was1± 0.7. Using BIND scoring criteria, 48% had subtle acute bilirubin encephalopathy. All BIND positive neonates passed AABR.
Conclusion – The incidence of bilirubin induced neurological dysfunction was 48% (Subtle BIND) in neonates with significant hyperbilirubinemia. The amalgamation of the BIND scoring system in all hyperbilirubinemia neonates’ checklist at the time of admission is recommended
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Vijayakumar Biradar
Dept of Pediatrics, BLDE(DU), Shri B.M. Patil Medical College, Hospital & Research Centre, Vijayapura, Karnataka, India.
Atul A Thobbi
Dept of Pediatrics, BLDE(DU), Shri B.M. Patil Medical College, Hospital & Research Centre, Vijayapura, Karnataka, India.
Siddu Charki
Assistant Professor & Chief Consultant Neonatologist. BLDE(DU) Shri B M Patil Medical College Hospital and Research Center, Vijayapura, Karnataka, India.
S V Patil
Dept of Pediatrics, BLDE(DU), Shri B.M. Patil Medical College, Hospital & Research Centre, Vijayapura, Karnataka, India.
M M Patil
Dept of Pediatrics, BLDE(DU), Shri B.M. Patil Medical College, Hospital & Research Centre, Vijayapura, Karnataka, India.