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Early prediction of adverse outcomes in infants with acute bilirubin encephalopathy
Wenqing Kang1, Xiao Yuan2, Yaodong Zhang1
1Neonatal Intensive Care Unit, Zhengzhou Key Laboratory of Newborn Disease Research, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou, 450018, China.
Insights
Early identification of adverse outcomes in infants with acute bilirubin encephalopathy (ABE) is crucial. The bilirubin-albumin ratio and BIND score effectively predict ABE complications, with their combination offering 100% prediction sensitivity.
Area of Science:
- Neonatology
- Pediatric Neurology
- Biochemistry
Background:
- Acute bilirubin encephalopathy (ABE) is a significant cause of neonatal mortality and long-term disability.
- Early detection and intervention are vital for improving outcomes in infants with ABE.
Purpose of the Study:
- To identify early predictors of adverse outcomes in newborns diagnosed with ABE.
- To evaluate the predictive value of the bilirubin-albumin ratio and BIND score for ABE complications.
Main Methods:
- The study included newborns aged ≥35 weeks gestational age with ABE.
- Key parameters measured included the Bilirubin-Induced Neurological Dysfunction (BIND) score, peak total serum bilirubin (TSB), and serum albumin levels.
- Adverse outcomes were defined as mortality or survival with auditory dysfunction and/or cerebral palsy.
Main Results:
- Of 76 infants analyzed, 25 experienced adverse outcomes.
- Bivariate logistic regression revealed that the bilirubin-albumin ratio (B/A) (OR 10.48) and BIND score (OR 3.68) were significantly correlated with adverse outcomes.
- ROC curve analysis indicated that a B/A ≥ 8.9 mg/g or a BIND score ≥ 6 could predict adverse outcomes; combining both parameters achieved 100% prediction sensitivity.
Conclusions:
- Both the bilirubin-albumin ratio and the BIND score are valuable predictors of adverse outcomes in ABE.
- The combined use of the B/A ratio and BIND score significantly enhances prediction sensitivity for ABE complications.
Objective:
Acute bilirubin encephalopathy (ABE) remains one of the important causes of neonatal mortality and child disability, early identification, and intervention which could improve outcomes. The purpose of this study was to evaluate early predictors of adverse outcomes in infants with ABE.
Methods:
Newborns of gestational age ≥ 35 weeks and diagnosed with ABE were included in the study. Bilirubin-induced neurological dysfunction (BIND) score, total serum bilirubin (TSB) peak value, and serum albumin levels were determined. Adverse outcomes were defined as death or survival with auditory dysfunction and/or cerebral palsy.
Results:
Eighty-two infants were eligible for recruitment in the study. The outcome data from 76 ABE infants (92%) were used for analysis, of which 25 infants got adverse outcomes and 51 live a normal life. Univariate analysis for BIND score, TSB peak value, bilirubin-albumin ratio (B/A), albumin level, abnormal AABR, and neonatal sepsis was performed to elucidate the association with adverse outcomes. Bivariate logistic regression analysis showed B/A (OR 10.48, 95%CI: 1.55-70.81, P = 0.02) and BIND score (OR 3.68, 95%CI: 1.39-9.72, P = 0.01) were correlated with adverse outcomes. ROC curve analysis showed that B/A (≥8.9 mg/g), BIND score (≥6) could predict adverse outcomes of ABE separately; B/A in conjunction with BIND score could increase prediction sensitivity to 100%.
Interpretation:
Both B/A and BIND score can be used to predict adverse outcomes of ABE, and the combination of the two parameters can increase prediction sensitivity significantly.
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