A modified Bilirubin-induced neurologic dysfunction (BIND-M) algorithm is useful in evaluating severity of jaundice in a resource-limited setting

Paula G. Radmacher, Frank D. Groves, Joshua A. Owa, Gabriel E. Ofovwe, Emmanuel A. Amuabunos, Bolajoko O. Olusanya, Tina M. Slusher

Research output: Contribution to journalArticlepeer-review

24 Scopus citations

Abstract

Background: Severe neonatal jaundice with associated acute bilirubin encephalopathy occurs frequently in low- and middle-income countries, where advanced diagnostic technology is in short supply. In an effort to facilitate the physical diagnosis of acute bilirubin encephalopathy, we pilot-tested a modified bilirubin induced neurologic dysfunction scoring algorithm in a group of pediatric trainees (residents) and their mentors (consultants) in a resource-constrained setting. Methods: Jaundiced Nigerian infants were examined by consultant and resident pediatricians. The modified bilirubin induced neurologic dysfunction score assigned by residents was compared with the clinical diagnosis of acute bilirubin encephalopathy by expert consultants. Demographic information was obtained. Known risk factors were also evaluated among infants with and without acute bilirubin encephalopathy in addition to exploratory analyses. Data were analyzed by Statistical Analysis System; statistical significance was set at p < 0.05. Results: Three hundred and thirty three paired modified bilirubin induced neurologic dysfunction scores (333) were analyzed and showed excellent agreement (weighted Kappa coefficient 0.7969) between residents and consultants. A modified bilirubin induced neurologic dysfunction score greater than or equal to 3 was highly predictive of a clinical diagnosis of acute bilirubin encephalopathy, with sensitivity of 90.7%, specificity of 97.7%, positive predictive value of 88.9%, and negative predictive value of 98.2%. Exposure to mentholated products was strongly associated with increased risk of acute bilirubin encephalopathy among those with known glucose-6-phosphate dehydrogenase deficiency (odds ratio = 73.94; 95% confidence interval = 5.425-infinity) as well as among those whose G6PD phenotype was unknown (odds ratio = 25.88; 95% confidence interval = 2.845-235.4). Conclusions: The modified bilirubin induced neurologic dysfunction score for neonatal jaundice can be assigned reliably by both residents and experienced pediatricians in resource-limited settings as reflected in the algorithm's sensitivity and specificity. It may be useful for predicting the development and severity of acute bilirubin encephalopathy in neonates.

Original languageEnglish (US)
Article number28
JournalBMC Pediatrics
Volume15
Issue number1
DOIs
StatePublished - Apr 1 2015

Bibliographical note

Funding Information:
The authors would like to express their thanks to Drs. Lois Johnson and Vinod Bhutani for sharing the BIND and allowing us to modify it. Additional thanks to Dr. Vinod Bhutani of Stanford University, Stanford, CA, USA for his kind suggestions and edits. This work was supported by a Basic Grant Program award received by Dr. Paula Radmacher (Intramural Grant to PGR). She received a $10,000 grant from the School of Medicine, University of Louisville.

Publisher Copyright:
© Radmacher et al.; licensee BioMed Central.

Keywords

  • Acute bilirubin encephalopathy
  • Evaluation of BIND score
  • Severe neonatal jaundice

Fingerprint

Dive into the research topics of 'A modified Bilirubin-induced neurologic dysfunction (BIND-M) algorithm is useful in evaluating severity of jaundice in a resource-limited setting'. Together they form a unique fingerprint.

Cite this