Can bilirubin/albumin ratio predict neurodevelopmental outcome in severe neonatal hyperbilirubinemia? A 3-month follow up study

Background The risk of kernicterus and BIND may be in part determined by total serum bilirubin (TSB) and by the level of non-albumin bound free bilirubin, which can easily pass the blood–brain barrier. Free bilirubin (Bf) seems a more reliable predictor for bilirubin neurotoxicity. Bilirubin/albumin...

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Veröffentlicht in:The Gazette of the Egyptian Paediatric Association 2021-02, Vol.69 (1), p.1-8, Article 4
Hauptverfasser: Soliman, Reem M., Iskander, Iman F., Elmazzahy, Esraa A., Abdellatif, May A. K.
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Sprache:eng
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Zusammenfassung:Background The risk of kernicterus and BIND may be in part determined by total serum bilirubin (TSB) and by the level of non-albumin bound free bilirubin, which can easily pass the blood–brain barrier. Free bilirubin (Bf) seems a more reliable predictor for bilirubin neurotoxicity. Bilirubin/albumin ratio (B/A) is considered a surrogate parameter for Bf and has been more useful than TSB. The aim of the study is to determine whether B/A ratio correlates with BIND in newborns with severe hyperbilirubinemia and if it can predict poor neurologic outcome at 3 months follow up. Results This prospective study included one hundred seventeen outborn neonates ≥ 35 weeks admitted in a tertiary care neonatal intensive care unit, between May and December 2012, with TSB ≥ 20 mg/dl or necessitating exchange transfusion. Total serum bilirubin and serum albumin were done on admission and bilirubin/albumin ratio was calculated. BIND score was calculated. At the age of 3 months, 112 neonates were followed up with a detailed neurological assessment. Babies who depicted any abnormal motor examination were subjected to brain stem auditory evoked response and MRI examination. Seven infants (6.2%) presented with kernicterus on follow up. BIND scores on admission, mean TSB, and bilirubin/albumin ratio was significantly higher in kernicteric infants compared with those having normal neurological outcome at 3 months of age ( P 0.001). The lowest TSB level at which kernicterus occurred in our study was 31 mg/dl. Receiver operation characteristics analysis identified B/A ratio cut off value for predicting kernicterus of 9.6 with sensitivity of 100% and specificity of 91.4%, whereas TSB cut off value of 30 mg/dl showed sensitivity of 100% and specificity of 83%. Conclusion B/A ratio is a strong indicator for the risk of kernicterus. B/A is more specific than TSB and should be used in the early management of neonatal hyperbilirubinemia.
ISSN:2090-9942
1110-6638
2090-9942
DOI:10.1186/s43054-021-00050-6