Screening for Bilirubin Induced Neurological Dysfunction (Bind) Among Hyperbilirubinemic Neonates, A Hospital Based Prospective Study.

Abstract

Background: Hyperbilirubinemia is a common and often benign problem in neonates. Around 60% of term neonates and 80% of preterm neonates develop hyperbilirubinemia during neonatal period. Untreated unconjugated hyperbilirubinemia is potentially neurotoxic which may cause neonatal morbidity and mortality characterised by bilirubin induced neurological dysfunction (BIND), kernicterus and subsequently chorio-athetoid cerebral palsy. Study justification: The local incidence of BIND is not known and BIND scoring criteria is not been adopted as standard for hyperbilirubinemic neonates’ assessment. The study is set to estimate magnitude of the problem as it is easily preventable with simple measures. Objectives: To determine Incidence of BIND and to assess the correlation of risk factors for BIND in neonates with hyperbilirubinemia. Methods: A hospital based prospective observational study conducted in Shri B M Patil Medical College Hospital and Research center from December 2019 to June 2020. All neonates with gestational age >35 weeks presenting with hyperbilirubinemia were enrolled. A sample of 173 hyperbilirubinemic neonates were enrolled in the study. Serum Bilirubin level estimation was done if neonate was icteric. Criteria for Significant Hyperbilirubinemia were decided on the basis of American Academy of Pediatrics (AAP) guidelines. In case of significant hyperbilirubinemia BIND scoring was assessed. BIND scoring system was applied to detect changes in mental status, muscle tone, and cry pattern of significant hyperbilirubinemia neonates. In all BIND positive babies AABR was performed. DocuSign Envelope ID: 473745582B6E648E--82928CE3-4-45CCBFF-9-9FB9E4-46-28677A47B24E6BD1F3EF508 x 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 ±259.2. grams. 83 (48%) mothers were primi parous and 90 (52%) mothers were multiparous. 125 (72.3%) neonates were term and 48 (27.7%) neonates were preterm. O positive (55.5%) was most common maternal blood group. A positive was most common baby’s blood group.115 (66.5%) babies were delivered normal vaginally and 58 (33.5%) babies were delivered via LSCS. ABO incompatibility (38%) was most common maternal risk factor. Low intake of breast milk (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 14.1 mg/dl ± 3.2 mg/dl with maximum being 27mg/dl. Mean unconjugated bilirubin was 13.2 mg/dl ± 3.0 mg/dl with maximum being 26.3 mg/dl. Mean BIND score was 1 ± 0.7. Using BIND scoring criteria, the incidence of BIND was as follows according to severity, 48% had subtle acute bilirubin encephalopathy, acute bilirubin encephalopathy was 0% and chronic bilirubin encephalopathy were 0%. All BIND positive neonates passed AABR. Conclusion – The incidence of bilirubin induced neurological dysfunction was 48% (Subtle BIND). We suggest the amalgamation of the BIND scoring system in all hyperbilirubinemic neonate’s checklist at the time of admission