Utilizing the Bilirubin-Albumin Ratio as a Predictive Marker for Bilirubin-Induced Neurologic Dysfunction: A Comparative Analysis in Two Referral Hospitals in Abeokuta

Abstract

Aim: We aim to assess the predictive value of Bilirubin Albumin Ratio (BAR) for evaluating bilirubin-induced neurologic dysfunction (BIND). Bilirubin-induced neurologic dysfunction is a major cause of morbidity in neonates with highest burden in Sub-Saharan Africa and other resource-limited settings. Bilirubin Albumin Ratio (BAR) has been purported to correlate better with BIND than total serum bilirubin (TSB) which is the conventional tool used in evaluating babies with severe hyperbilirubinemia. There is however paucity of studies utilizing BAR in evaluating BIND. Study Design: The study design was cross-sectional. Place and Duration of Study: Neonatal Units of two referral hospitals; Federal Medical Centre Abeokuta and Sacred Heart Hospital Abeokuta in Ogun State, Nigeria between October 2019 – May 2020. Methods: We included 84 late preterm and term babies with severe hyperbilirubinemia in the first 14 days of life. Babies were grouped into those with and without BIND using the modified BIND score, their sera was assessed for total serum bilirubin, and albumin and the BAR was calculated by dividing the plasma bilirubin level by serum albumin and findings were compared between the two groups. Results: Bilirubin-induced neurologic dysfunction was present in 67.9% of babies with severe hyperbilirubinemia with a male: female ratio of 1.8:1. The mean BAR for babies with and without BIND were 7.77 ± 1.76 and 5.43 ± 1.27 mg/g respectively. Babies with BIND had a significantly higher BAR than those without BIND (p < .001). Using the receiver operating characteristic curve analysis, the cut-off value for BAR was 6.46 mg/g with sensitivity, and specificity of 84.2% and 81.5% respectively. Conclusion: The prevalence of BIND among babies with severe hyperbilirubinemia is high and BAR has a high predictive value in evaluating babies at risk of developing BIND.