There is a scoring system to judge the Bilirubin-Induced Neurologic

Disfunction (BIND) of a baby5 .These scores represent levels

of Acute Bilirubin Encephelopathy (ABE) or brain damage. Peak
scores of 1-3 represent reversible classic kernicterus, but they may
also be linked to permanent impairment that is more subtle.
Bind
Score:

Mental
Status

Muscle
Tone

Cry
Pattern

Normal

Sleepy but
arousable;
decreased
feeding

Lethargy, poor
suck
and/or
irritable/jittery
with strong suck

Semi-coma,
apnea, unable
to feed,
seizures, coma

Normal

Mild to moderate
Persistent
hypertonia
Persistent mild
arching of head,
alternating
to
neck and body,
with hypotonia,
moderate
bicycling or
beginning arching
hypotonia
twitching of
of
hands and feet
neck and trunk on

Normal

High pitched
when aroused

Abbreviations:
BIND,
bilirubin-induced
ABE,
acute
TSB,
total
ABR, auditory brainstem response

Shrill, difficult
to console

neurological
bilirubin
serum

Inconsolable
crying or cry
weak or absent
dysfunction
encephalopathy
bilirubin

Score of 79 represent advanced ABE: urgent, prompt and individualized

intervention are recommended to prevent further brain damage, minimize
severity of sequelae and possibly reverse acute damage.
Score of 46: represent moderate ABE and are likely to be reversible with
urgent and prompt bilirubin reduction strategies.
Score of 13: are consistent with subtle signs of ABE in infants with

hyperbilirubinemia. An abnormal ABR or referred automated ABR is

indicative of likely bilirubin neurotoxicity and would be suggestive of
moderate ABE. In infants with these non-specific signs (score 13), a failed
ABR hearing screen supports a diagnosis of moderate ABE. Serial ABR
may be used as an objective measure of progression, stabilization or
reversal of acute auditory damage and could interpret effectiveness of
bilirubin reduction strategies.5