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Published on: November 20, 2015
Unbound Bilirubin and Acute Bilirubin Encephalopathy in Infants Born Late Preterm and Term with Significant
Sanjiv B Amin1, Satish Saluja2, Neelam Kler2
1Department of Pediatrics, Central Michigan University, Mount Pleasant, MI; Department of Pediatrics, Sir Ganga Ram Hospital, Delhi, India.
Insights
Unbound bilirubin (UB) is more strongly associated with acute bilirubin encephalopathy (ABE) than total serum bilirubin or the bilirubin:albumin molar ratio in infants. BIND scoring can help evaluate ABE in newborns.
Area of Science:
- Neonatal Medicine
- Pediatric Neurology
- Biochemistry
Background:
- Hyperbilirubinemia is common in newborns, posing a risk for acute bilirubin encephalopathy (ABE).
- Assessing ABE severity and predicting outcomes relies on accurate bilirubin measurements.
- Existing markers like total serum bilirubin (TSB) may not fully capture the risk.
Purpose of the Study:
- To compare the predictive value of unbound bilirubin (UB), TSB, and bilirubin:albumin molar ratio (BAMR) for ABE.
- To evaluate the association of these markers with the severity of ABE using the bilirubin-induced neurologic dysfunction (BIND) score.
Main Methods:
- Prospective cohort study of 151 infants ≥34 weeks gestational age with significant hyperbilirubinemia.
- Measurements included TSB, serum albumin, and UB.
- ABE was assessed using the standardized BIND score upon admission.
Main Results:
- 37% of infants studied had ABE, with 18 cases of moderate-to-severe ABE.
- Unbound bilirubin (UB) was significantly associated with ABE (aOR 1.64).
- UB also correlated with ABE severity (aOR 1.76), unlike TSB or BAMR.
Conclusions:
- Unbound bilirubin is a stronger predictor of ABE than TSB or BAMR in infants.
- BIND scoring, utilizing UB measurements, can aid in evaluating ABE in newborns ≥34 weeks gestational age.
Objective:
To compare the association of unbound bilirubin (UB), total serum bilirubin (TSB), and bilirubin:albumin molar ratio (BAMR) with acute bilirubin encephalopathy (ABE), as assessed by bilirubin-induced neurologic dysfunction (BIND) score, in infants with significant hyperbilirubinemia (TSB ≥20 mg/dL or underwent exchange transfusion).
Study Design:
In this prospective cohort study, infants ≥34 weeks of gestational age with significant hyperbilirubinemia during the first 2 postnatal weeks were eligible, unless they had craniofacial malformations, chromosomal disorders, TORCH (toxoplasmosis, other infections, rubella, cytomegalovirus and herpes simplex) infections, surgery, or a family history of congenital deafness. TSB, serum albumin, and UB were measured at hospital admission using the colorimetric, bromocresol green, and modified peroxidase method, respectively. Infants were evaluated on admission for ABE using a standardized neurologic examination and assigned a BIND score by trained physicians. Infants with a total BIND score of 0 were deemed to not have ABE, whereas those with a score ≥1 were deemed to have ABE.
Results:
A total of 151 infants were studied, among whom 37 (24.5%) had ABE. Of these, 19 had mild ABE (BIND score 1-3) and 18 had moderate-to-severe ABE (BIND score 4-9). On logistic regression, UB, but not TSB or BAMR, was associated with ABE (aOR 1.64; 95% CI 1.17-2.3). On ordered logistic regression, UB, but not TSB or BAMR, was associated with severity of ABE (aOR 1.76; 95% CI 1.28-2.4).
Conclusions:
Our findings of the association between UB and ABE indicate that BIND scoring may be useful for evaluation of ABE in infants ≥34 weeks of gestational age.
