Editor's Note MS#20162317 El Houchi et al - Neonatal jaundice: more than a number

Abstract

Severe neonatal jaundice (unconjugated hyperbilirubinemia) may cause permanent brain injury and hearing loss in infants worldwide, including those born in developed countries. Bilirubin neurotoxicity is due to the effects of unbound unconjugated bilirubin in the central nervous system. The risk of kernicterus depends not only on the total serum bilirubin, but also factors such as the bilirubin-albumin binding capacity, prematurity, and other neonatal illnesses. In this volume of The Journal, El Houchi et al describe their use of the Bilirubin Induced Neurologic Dysfunction (BIND) Score to evaluate neurotoxicity in infants with severe hyperbilirubinemia, with the hope of improving our ability to detect infants who require timely exchange transfusions. The BIND score evaluates three aspects of the physical examination including mental status,muscle tone and cry pattern on a 0- to 3-point rating scale. In 220 near-term and full-terminfants admitted to their hospital with severe hyperbilirubinemia, El Houchi et al noted that regardless of the total serum bilirubin, infants with BIND scores of 3-4 or more were at increased risk for persistent neurologic abnormalities at 3-5 months of age. The etiology of jaundice for the infants in this study was not described, and the gestational age of the infants was not precisely known. These two factors suggest that further replication of these findings is needed to understand the usefulness of the BIND score across a variety of at-risk populations. However, in this study, El Houchi et al have shown that serial neurologic examinations are an important and cost-effective adjunct to the total serum bilirubin in the evaluation and management of jaundice that should be useful to pediatricians worldwide. Article page 51 ▶ Prediction of 3- to 5-Month Outcomes from Signs of Acute Bilirubin Toxicity in Newborn InfantsThe Journal of PediatricsVol. 183PreviewTo evaluate the ability of the bilirubin-induced neurologic dysfunction (BIND) score to predict residual neurologic and auditory disability and to document the relationship of BIND score to total serum bilirubin (TSB) concentration. Full-Text PDF