A neurologic dysfunction scoring protocol for jaundiced neonates requiring exchange transfusion

Abstract

Aim: 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.

Keywords:

• Acute bilirubin encephalopathy
• neurological examination
• newborn care
• exchange transfusion
• late presentation

Acknowledgements

We thank Tina Slusher for participating in training pediatric residents who completed the BIND-M scoring forms used in this paper. The research team at the Centre for Healthy Start Initiative as well as Lekan Kehinde and Femi Olaosebikan assisted with data management.

Disclosure statement

The authors have no conflicts of interest to declare.

Additional information

Funding

The BIND-M data used in this paper were derived from a substantive research funded by the National Institutes of Health (NIH): # 1R21HD068203. Advanced Instruments Norwood, MA subsidized BR2 kits for our Advanced Bilirubin Stat-Analyzer.