Section Neonatal jaundice may be the most under-recognized cause of neonatal morbidity and mortality in the developing world. Most deliveries in developing countries occur outside of referral hospitals, in settings where diagnosis of and treatments for jaundice are often unavailable or suboptimal. Untreated neonatal jaundice can lead to acute bilirubin encephalopathy (ABE). Data from large referral hospitals strongly suggests that ABE is a major cause of neurologic disability (cerebral palsy, deafness, language difficulty) and death in neonates in developing countries. However, no ABE prevalence estimates are currently available for developing countries. Large-scale efforts to prevent ABE are crucial, but are unlikely to occur until the actual burden of disease from severe jaundice is appreciated. The central hypothesis of this study is that ABE is common in the developing world and specifically in Nigeria but is under-recognized due to the lack of appropriate survey instruments.
Our specific aims are to: 1) Validate the BIND II score in a Nigerian hospital. The BIND II will be performed by consultant pediatricians and validated uingboh cliniclexmand the auditory brainstem response (ABR) in neonates d14days old with serum bilirubin levels elevated for age. 2) Develop the C- BIND score and validate it in a Nigerian hospital/clinic setting. We wil develop the C- BIND from the BIND II by translating the BIND II into lay language using both professional and lay colleagues in Nigeria. It will incorporate pictures and short video and audio clips, as well as the questions from the BIND II in lay language but will not involve any exam by the lay workers. We will then train lay workers from Ife to perform the C-BIND on infants originally enrolled in Aim 1 and validate those scores. 3) Conduct a pilot study to determine the prevalence of ABE in one Nigerian community by using the C-BIND. We will take the C-BIND tool into one community in Nigeria and survey this community, using the tool to determine the prevalence of ABE in that community as a means of determining its feasibility for determining the prevalence of ABE on a larger scale--first in Nigeria, and then in other parts of the developing world.
This study will develop and/or validate two survey tools and then do a pilot study to determine the prevalence of acute bilirubin encephalopathy (ABE) in Ife, Nigeria. We believe that our study will be the first step in determining the prevalence of ABE in the developing world and hence the first step in developing both testing and interventions to prevent the brain injury caused by ABE. This study has the potential to lead to the prevention of brain injury in thousands of children in the developing world by laying the foundation for many public health interventions to decrease the occurrence of ABE.