A neurologic dysfunction scoring protocol for jaundiced neonates requiring exchange transfusion

<b>Aim:</b> To evaluate the performance of a neurologic assessment protocol among jaundiced infants requiring exchange transfusion (ET). <b>Methods:</b> 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 <i>c</i>-statistic. <b>Results:</b> 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 (<i>c</i>-statistic range: 0.693–0.791). <b>Conclusions:</b> 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.

【研究目的】评估针对需接受换血疗法（exchange transfusion, ET）的黄疸婴儿的神经评估方案的效能。【研究方法】本研究纳入某转诊儿童医院内接受ET的婴儿，以及符合美国儿科学会（American Academy of Pediatrics, AAP）基于血清总胆红素（total serum bilirubin, TSB）水平制定的ET指征的婴儿。通过logistic回归分析（logistic regression analysis）与C统计量（c-statistic），探究胆红素诱导神经功能障碍（bilirubin-induced neurologic dysfunction, BIND-M）评分方案用于检测急性胆红素脑病（acute bilirubin encephalopathy, ABE）时，对两组中接受ET的婴儿的识别效能。【研究结果】本研究共纳入438例晚期早产儿与足月儿，其中141例（32.2%）接受了ET，155例（35.4%）符合AAP制定的ET指征。在两组中，BIND-M评分为3~6分（中度ABE）或7~12分（重度ABE）的婴儿均与ET显著相关，但评分为1~2分（轻度ABE）的婴儿则无此关联，无论是否校正混杂神经毒性危险因素。不过，BIND-M回归模型的区分能力仅为中等尚可（C统计量范围：0.693~0.791）。【研究结论】本研究结果表明，BIND-M可作为ET决策的潜在实用工具，并支持当前针对中重度ABE婴儿无论血清总胆红素水平如何均需立即行ET的推荐意见。