BIND Score (Bilirubin-Induced Neurologic Dysfunction)

Evaluates severity of neonatal jaundice and associated acute bilirubin encephalopathy.

Refer to the text below the calculator for more information on the two studies, for the original and modified version of the BIND score.


The BIND score and the subsequent modified BIND-M score evaluate severity of jaundice in neonatal patients based on clinical signs.

Acute bilirubin encephalopathy (ABE) is a potentially devastating condition occurring in neonates that can lead to death or life-long neurodevelopmental impairment. Its early diagnosis and intervention to reduce bilirubin can in moderate cases revert damage and in severe cases at least limit the severity of the damage.


BIND Score Interpretation

  • 0: No indication of acute bilirubin encephalopathy (ABE);
  • 1-3: Subtle signs of mild acute bilirubin encephalopathy (ABE);
  • 4-6: Moderate acute bilirubin encephalopathy (ABE), urgent bilirubin reduction intervention is likely to reverse the acute damage;
  • 7-9: Advanced acute bilirubin encephalopathy (ABE), urgent bilirubin intervention is needed to prevent further brain damage and reduce the severity of sequelae.

BIND-M Score Interpretation

  • <3: No indication of diagnosis of acute bilirubin encephalopathy (ABE);
  • ≥3: Positive diagnosis of acute bilirubin encephalopathy (ABE).

1

Mental Status

2

Muscle Tone

3

Cry Pattern

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1

Mental Status

2

Muscle Tone

3

Cry Pattern

4

Altered Gaze

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The BIND Score explained

The BIND score and the subsequent modified BIND-M score evaluate severity of jaundice in neonatal patients and associated acute bilirubin encephalopathy (ABE) based on clinical signs.

Acute bilirubin encephalopathy (ABE) is a potentially devastating condition occurring in neonates that can lead to death or life-long neurodevelopmental impairment. Its early diagnosis and intervention to reduce bilirubin can in moderate cases revert damage and in severe cases at least limit the severity of the damage.

Item BIND score BIND-M score
Mental Status Normal (0)
Sleepy but arousable; decreased feeding (+1)
Lethargy, poor suck and/or irritable/jittery with strong suck (+2)
Semi-coma, apnoea, unable to feed, seizures, coma (+3)
Muscle Tone Normal (0)
Persistent mild to moderate hypotonia (+1)
Mild to moderate hypertonia alternating with hypotonia, beginning arching of neck and trunk on stimulation (+2)
Persistent retrocollis and opisthotonos – bicycling or twitching of hands and feet (+3) Persistent retrocollis and opisthotonos; crossing or scissoring of arms or legs but without spasms of arms and legs and without trismus (+3)
Cry Pattern Normal (0)
High pitched when aroused (+1)
Shrill, difficult to console (+2)
Inconsolable crying or cry weak or absent (+3)
Altered Gaze - Normal gaze (0)
Sun-setting; paralysis of upward gaze (+3)

BIND Score Interpretation

  • 0: No indication of acute bilirubin encephalopathy (ABE);
  • 1-3: Subtle signs of mild acute bilirubin encephalopathy (ABE);
  • 4-6: Moderate acute bilirubin encephalopathy (ABE), urgent bilirubin reduction intervention is likely to reverse the acute damage;
  • 7-9: Advanced acute bilirubin encephalopathy (ABE), urgent bilirubin intervention is needed to prevent further brain damage and reduce the severity of sequelae.

BIND-M Score Interpretation

  • <3: No indication of diagnosis of acute bilirubin encephalopathy (ABE);
  • ≥3: Positive diagnosis of acute bilirubin encephalopathy (ABE).

333 paired modified bilirubin induced neurologic dysfunction scores were analyzed and showed excellent inter-rater agreement.

A modified bilirubin induced neurologic dysfunction score greater than or equal to 3 was found to be highly predictive of a clinical diagnosis of acute bilirubin encephalopathy, with the following statistical properties:

  • Sensitivity: 90.7%;
  • Specificity: 97.7%;
  • Positive predictive value: 88.9%;
  • Negative predictive value: 98.2%.

The study concluded that the modified bilirubin induced neurologic dysfunction score for neonatal jaundice may be useful for predicting the development and severity of acute bilirubin encephalopathy in neonates.

 

References

Original reference

Johnson LH, Brown AK, Bhutani VK. BIND - a clinical score for bilirubin-induced neurologic dysfunction in newborns. Pediatrics. 1999;199(3 part 3):746–7.

Radmacher PG, Groves FD, Owa JA, Ofovwe GE, Amuabunos EA, Olusanya BO, Slusher TM. A modified Bilirubin-induced neurologic dysfunction (BIND-M) algorithm is useful in evaluating severity of jaundice in a resource-limited setting. BMC Pediatr. 2015; 15: 28.

Other references

Johnson L, Bhutani VK, Karp K, Sivieri EM, Shapiro SM. Clinical Report From the Pilot USA Kernicterus Registry (1992 to 2004) J Perinatol. 2009; 29 Suppl 1:S25-45.

Shapiro SM. Definition of the clinical spectrum of kernicterus and bilirubin-induced neurologic dysfunction (BIND) J Perinatol. 2005; 25:54–9.


Specialty: Neonatology

Objective: Severity screening

Year Of Study: 1999 & 2015

Abbreviation: BIND / BIND-M

Article By: Denise Nedea

Published On: May 26, 2020

Last Checked: May 26, 2020

Next Review: June 25, 2025