Unbound bilirubin, a robust predictor of acute bilirubin encephalopathy in infants

Infants were assessed on admission for ABE using a standardized neurological examination. They were assigned a BIND score by trained physicians. Infants with a total BIND score of 0 were deemed normal and those with a score ≥ 1 were deemed to have ABE.

The study led to the following findings:

• A total of 151 infants were studied, among whom 37 had ABE. Of these,
• 19 had mild ABE [BIND score 1 to 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 (adjusted OR:1.64).
• On ordered logistic regression, UB, but not TSB or BAMR, was associated with the severity of ABE (adjusted OR:1.76).

"Unbound bilirubin levels, but not bilirubin: albumin molar ratio or total serum bilirubin, have emerged as a robust predictor of acute bilirubin encephalopathy occurrence and severity in infants ≥ 34 weeks GA," the researchers wrote.

"This emphasizes the importance of UB measurement incorporation into bilirubin-induced neurological dysfunction scoring for a more accurate evaluation in this patient cohort," they concluded.

Reference:

Amin SB, Saluja S, Kler N. Unbound Bilirubin and Acute Bilirubin Encephalopathy in Infants Born Late Preterm and Term with Significant Hyperbilirubinemia. J Pediatr. 2023 Dec 20:113880. doi: 10.1016/j.jpeds.2023.113880. Epub ahead of print. PMID: 38135027.