Additional file 1. Original BIND score scheme.

Stage 1A Stage 1B Stage II

BIND SCORE Early Moderate Severe, Semi-Coma, Apnea,
(1 point) (2 points) Convulsions
(3 points)
Mental Status Sleepy, Very sleepy Semi-Coma
(circle one) Difficult to Alternatively very Apnea
Awaken for irritable Convulsions
Feeding
Muscle Tone Tone slightly Tone moderately Tone markedly increased or
(circle one) decreased increased or decreased decreased. Opisthotonic
depending on arousal posturing. “Back bends”
state. Mild neck and “Bicycling” movements
back arching
Cry High pitched Shrill, very high Piercing, shrill inconsolable
(Circle one) pitched
Suck Weak/Poor Absent
(Circle one)
*Feeding Decreased Poor Absent
(Circle One)
**Yellowness (at Eyes/Face Trunk/Chest Abdomen and Below
any time) ** (Yellowness not scored but
(Circle One) included in record)
Table 1. Clinical BIND score of onset, severity and progression of ABE in infants with
hyperbilirubinemia (TSB >95th percentile for age in hours) as elicited by history and
physical examination

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Date__/__ Date__/__ Date__/__ Date__/__
Clinical signs BIND score ABE
Time_:_ Time_:__ Time_:__ Time_:_
Mental status
Normal 0 None
Sleepy but arousable; decreased
1 Subtle
feeding
Lethargy, poor suck and/or
2 Moderate
irritable/jittery with strong suck
Semi-coma, apnea, unable to feed,
3 Advanced
seizures, coma

Muscle tone
Normal 0 None
Persistent mild to moderate
1 Subtle
hypotonia
Mild to moderate hypertonia
alternating with hypotonia, beginning
2 Moderate
arching of neck and trunk on
stimulation
Persistent retrocollis and
opisthotonos—bicycling or twitching 3 Advanced
of hands and feet

Cry pattern
Normal 0 None
High pitched when aroused 1 Subtle
Shrill, difficult to console 2 Moderate
Inconsolable crying or cry weak or
3 Advanced
absent
Total BIND
score
Nurse/MD
signature

Abbreviations: BIND, bilirubin-induced neurological dysfunction; ABE, acute bilirubin

encephalopathy; TSB, total serum bilirubin.

Score of 7–9 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 4–6: represent moderate ABE and are likely to be reversible with urgent and prompt
bilirubin reduction strategies.
 Score of 1–3: 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 1–3), 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.

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