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BIND score: A system to triage infants readmitted for extreme hyperbilirubinemia
Numan Nafie Hameed1, Mustafa Amir Hussein2
1Department of Pediatrics, College of Medicine, Baghdad University, Baghdad, Iraq; Children Welfare Teaching Hospital, Medical City Complex, Bab Al Muadham, PO box 61023, Code, 12114 Baghdad, Iraq.
Insights
Extreme hyperbilirubinemia (EHB) in infants can cause severe harm. A total serum bilirubin (TB) over 30 mg/dL and a Bilirubin-Induced Neurologic Dysfunction (BIND) score of 4 or higher are key indicators for adverse outcomes.
Area of Science:
- Neonatal Medicine
- Pediatric Neurology
- Public Health
Background:
- Extreme hyperbilirubinemia (EHB), defined as total serum bilirubin (TB) >25 mg/dL, poses significant risks including death and bilirubin-induced neurologic dysfunction (BIND).
- A simplified triage system is crucial for managing EHB, particularly in low- to middle-income countries experiencing high incidence rates.
Purpose of the Study:
- To identify key determinants for adverse outcomes in infants readmitted for EHB.
- To evaluate the utility of TB levels and BIND scores in a systems approach for triaging EHB infants.
Main Methods:
- A cohort of 72 infants readmitted for EHB (TB: 28.1 ± 2.5 mg/dL) was studied.
- Infants were assessed for BIND scores, with a focus on those with scores ≥4.
- Outcomes such as acute bilirubin encephalopathy (ABE) and post-icteric sequelae were recorded.
Main Results:
- 20.8% of infants (15/72) had BIND scores ≥4.
- 15.3% of infants (11/72) with BIND scores of 4-6 developed moderate ABE, with over half experiencing sequelae.
- Infants with TB >30 mg/dL and BIND scores ≥4 showed a higher incidence of adverse outcomes, including one fatality.
Conclusions:
- Total serum bilirubin (TB) >30 mg/dL and a BIND score ≥4 are significant predictors of adverse outcomes in EHB.
- These findings support the use of TB levels and BIND scores for a systematic triage approach in managing infants with EHB.
- Implementing this triage system can help prevent severe complications and improve outcomes for infants with EHB.
Abstract:
Extreme hyperbilirubinemia [EHB, total serum bilirubin (TB) >25 mg/dL]) can lead to death, acute bilirubin encephalopathy (ABE), exchange transfusion, and/or bilirubin-induced neurologic dysfunction (BIND). In specific low- to middle-income countries, an "epidemic" exists, therefore, a simplified triage management system is needed. Here, we studied a cohort of 72 infants readmitted for EHB (TB: 28.1 ± 2.5; range: 25-42 mg/dL). Of these, 15/72 (20.8%) newborns had BIND scores ≥4. Eleven (15.3%) infants with BIND scores of 4 to 6 developed moderate ABE, with 6/11 (54.5%) with TB of 28.1 ± 4.8 mg/dL having post-icteric sequelae. Eight infants (TB of 32.1 ± 3.5 mg/dL) had BIND scores >6 and developed adverse outcomes. One infant, who had Rh disease and a BIND score of 8 died. We report that the key determinants for adverse outcomes were TB >30 mg/dL and a BIND score ≥4 and may be useful for a systems approach to triage infants readmitted for EHB.
