Radmacher et al modified the BIND score of Johnson, Brown and Bhutani for the evaluation of a neonate for evidence of bilirubin-induced neurologic dysfunction (acute bilirubin encephalopathy, ABE). The authors are from the University of Louisville, Obafemi Awolowa University, University of Benin, Centre for Healthy Start Initiative (Lagos), and the University of Minneapolis.
The main modification is addition of a measure for eye/oculomotor movements.
Parameters:
(1) mental status
(2) muscle tone
(3) cry pattern
(4) eye/oculomotor movements
Parameter
Finding
Points
mental status
normal
0
sleepy but rousable
1
decreased feeding
1
lethargy
2
poor suck
2
irritable/jittery with short-term strong suck
2
semi-coma or coma
3
apnea
3
seizures
3
muscle tone
normal
0
persistent mild hypotonia
1
moderate hypotonia
2
moderate hypertonia
2
increasing arching of neck and trunk on stimulation without spasms of arms and legs and without trismus
2
persistent retrocollis
3
opisthotonus
3
crossing or scissoring of arms and legs but without spasms of arms and legs and without trismus
3
cry pattern
normal
0
high-pitched
1
shrill
2
inconsolable
3
weak or absent in a child with a previous history of high-pitched or shrill cry
3
eye movements
normal
0
sun-setting
3
paralysis of upward gaze
3
where:
• The point assignment matches the severity of the sign (0 normal, 3 severe).
total score =
= SUM(points for all 4 parameters)
Interpretation:
• minimum score: 0 (normal)
• maximum score: 12 (severe)
• A score >= 3 had a sensitivity of 91% and specificity of 98% for BIND/ABE.
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