Role of Serum (B/A) Ratio Compared to (TSB) for Early Prediction of Bilirubin-induced Neurological Dysfunction (BIND).
NCT ID: NCT06603753
Last Updated: 2024-09-19
Study Results
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Basic Information
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NOT_YET_RECRUITING
80 participants
OBSERVATIONAL
2025-01-01
2026-07-01
Brief Summary
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Detailed Description
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Jaundice due to either indirect (unconjugated) or direct (conjugated) bilirubin within the first 24 h of life should be taken seriously. Early identification and proper management are needed to prevent the serious neurological complications .
When the total serum bilirubin (TSB) rises above the 95th percentile for age (high-risk zone), entry of unconjugated bilirubin into the brain can cause both short-term and long-term neurological dysfunctions (bilirubin encephalopathy) . The increased level of bilirubin is detrimental for nervous system, especially damage the basal ganglia, cerebellum, and brainstem, thus, resulting in bilirubin-induced neurological dysfunction (BIND) .
Bilirubin-induced neurologic dysfunction (BIND) is the term applied to the spectrum of neurologic abnormalities associated with hyperbilirubinemia. It can be further divided into characteristic signs and symptoms that appear in the early stages (acute) and those that evolve over a prolonged period (chronic) . Signs and symptoms of BIND include tone abnormalities such as hypotonia, hypertonia, retrocollis and opisthotonos, in association with varying degrees of drowsiness, lethargy, decreased feeding and irritability .
BIND was also associated with Kernicterus leading to devastating disability including athetoid cerebral palsy, speech and hearing impairment. BIND in neonates is a significant cause of death or lifelong disability, including cerebral palsy (CP) and auditory disorders .
The earliest signs and symptoms of BIND are nonspecific therefore may be easily missed thus an early diagnostic tool is required. BIND score is a scoring system, in which characteristics of mental state, muscle tone, and cry are grouped into three levels of increasing abnormality: stage IA, minimal signs; stage IB, progressive but reversible with treatment; stage II, advanced and largely irreversible, but may be significantly decreased by treatment .
The pathogenesis of BIND is multifactorial and includes interaction between the level of unconjugated bilirubin, free bilirubin, bilirubin bound to albumin, bilirubin passed through brain blood barrier and nerves damage. Although 99.9% of unconjugated bilirubin in the circulation is bound to albumin, a relatively small fraction (only less than 0.1%) remains unbound (free bilirubin) and it can go into the brain across an intact blood brain barrier (BBB) .
There is currently no method available for measuring free bilirubin concentrations accurately in plasma or serum; therefore, adjunct measurements of albumin concentration and bilirubin albumin ratio (B/A) may provide more insight into the likelihood of bilirubin-induced encephalopathy. The B/A ratio is considered a surrogate parameter for free bilirubin and an interesting additional parameter in the management of hyperbilirubinemia. Few studies suggested the utilization of B/A ratios as a predictor for bilirubin-induced neurotoxicity .
Conditions
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Study Design
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COHORT
PROSPECTIVE
Eligibility Criteria
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Inclusion Criteria
* Full term and preterm babies.
* Both sexes.
Exclusion Criteria
* Perinatal asphyxia.
* Patients with encephalopathy due to causes other than hyperbilirubinemia.
* Severe birth defects or congenital anomalies.
* Hemodynamic instability.
* Septic patients.
1 Day
28 Days
ALL
Yes
Sponsors
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alaa aboelhassan mohamed aboelhassan
OTHER
Responsible Party
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alaa aboelhassan mohamed aboelhassan
Assistant Lecturer
Principal Investigators
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Mahmoud A Ahmed, Dr
Role: STUDY_DIRECTOR
Assiut University
Jaafar I Mohamad, Prof
Role: STUDY_DIRECTOR
Assiut University
Central Contacts
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References
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Karimzadeh P, Fallahi M, Kazemian M, Taslimi Taleghani N, Nouripour S, Radfar M. Bilirubin Induced Encephalopathy. Iran J Child Neurol. 2020 Winter;14(1):7-19.
Hameed NN, Hussein MA. BIND score: A system to triage infants readmitted for extreme hyperbilirubinemia. Semin Perinatol. 2021 Feb;45(1):151354. doi: 10.1016/j.semperi.2020.151354. Epub 2020 Dec 1.
Paar M, Fengler VH, Reibnegger G, Schnurr K, Waterstradt K, Schwaminger SP, Stauber RE, Oettl K. Determination of binding characteristics as a measure for effective albumin using different methods. Biochim Biophys Acta Gen Subj. 2023 Sep;1867(9):130427. doi: 10.1016/j.bbagen.2023.130427. Epub 2023 Jul 15.
Wang Y, Sheng G, Shi L, Cheng X. Increased serum total bilirubin-albumin ratio was associated with bilirubin encephalopathy in neonates. Biosci Rep. 2020 Jan 31;40(1):BSR20192152. doi: 10.1042/BSR20192152.
El Houchi SZ, Iskander I, Gamaleldin R, El Shenawy A, Seoud I, Abou-Youssef H, Wennberg RP. Prediction of 3- to 5-Month Outcomes from Signs of Acute Bilirubin Toxicity in Newborn Infants. J Pediatr. 2017 Apr;183:51-55.e1. doi: 10.1016/j.jpeds.2016.12.079. Epub 2017 Jan 25.
Ding Y, Wang S, Guo R, Zhang A, Zhu Y. High levels of unbound bilirubin are associated with acute bilirubin encephalopathy in post-exchange transfusion neonates. Ital J Pediatr. 2021 Sep 15;47(1):187. doi: 10.1186/s13052-021-01143-z.
Kang W, Yuan X, Zhang Y, Song J, Xu F, Liu D, Li R, Xu B, Li W, Cheng Y, Zhu C. Early prediction of adverse outcomes in infants with acute bilirubin encephalopathy. Ann Clin Transl Neurol. 2020 Jul;7(7):1141-1147. doi: 10.1002/acn3.51077. Epub 2020 Jun 4.
Kasirer Y, Kaplan M, Hammerman C. Kernicterus on the Spectrum. Neoreviews. 2023 Jun 1;24(6):e329-e342. doi: 10.1542/neo.24-6-e329.
Other Identifiers
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B/A ratio to predict of bind
Identifier Type: -
Identifier Source: org_study_id
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