The influencing factors of amplitude-integrated electroencephalography and bilirubin-induced neurological dysfunction scores in neonates with hyperbilirubinemia: a cross-sectional study.

BACKGROUND

Amplitude-integrated electroencephalography (aEEG) and bilirubin-induced neurological dysfunction (BIND) scores are important bedside tools for evaluating neonatal brain function, particularly regarding bilirubin-induced brain injury. This study aimed to analyze the influencing factors of aEEG and BIND scores in neonates with hyperbilirubinemia.

METHODS

A total of 294 neonates with gestational ages of ≥ 35 weeks, diagnosed with hyperbilirubinemia were enrolled. All infants underwent bedside aEEG monitoring and BIND scoring within 48 h after admission, with assessors blinded to laboratory results. Clinical and laboratory data were collected. Univariate analysis, logistic regression, correlation analysis, and receiver operating characteristic (ROC) curve analysis were performed.

RESULTS

① The indirect bilirubin/albumin ratio (IB/A) was significantly associated with abnormal aEEG scores (OR = 1.722, 95% CI = 1.436–2.066) and abnormal BIND scores (OR = 1.251, 95% CI: 1.050–1.491). Sensitivity analysis confirmed similar associations for total bilirubin (TB), indirect bilirubin (IB), and total bilirubin/albumin ratio (TB/A). ② The area under the ROC curve (AUC) of IB/A for identifying abnormal aEEG and abnormal BIND scores was 0.736 and 0.587, respectively. The optimal cutoff values (8.7 and 7.7) showed high specificity (95.2% and 70.5%) but low sensitivity (43.9% and 47.1%). ③ aEEG scores were negatively correlated with TB, IB, TB/A, IB/A, albumin (ALB), and corrected gestational age (CA) (all P < 0.05). BIND scores were negatively correlated with aEEG scores and positively correlated with TB/A (both P < 0.05). Birth weight, Birth length, maternal age, day age, and lactate dehydrogenase (LDH) showed no significant correlations with either score (all P > 0.05).

CONCLUSIONS

In neonates ≥ 35 weeks of gestation with hyperbilirubinemia and mainly mild neurological dysfunction, serum bilirubin burden represented by IB/A is an independent core factor associated with abnormal bedside aEEG and BIND scores. Conventional demographic and perinatal indexes, including birth weight, birth length, maternal age, day age, and delivery mode, show no significant influence on the two scores in this study population.