BIND-M Calculator

BIND-M Assessment

Select the most severe clinical sign present in each domain. The BIND-M score ranges from 0 to 12.

1. Mental Status

Normal 0 Sleepy but arousable; decreased feeding 1 Lethargy; poor suck; and/or irritable/jittery with short-term strong suck 2 Semi-coma; apnea; unable to feed; seizures; coma 3

2. Muscle Tone

Normal 0 Persistent mild to moderate hypotonia 1 Mild to moderate hypertonia alternating with hypotonia; beginning arching of neck and trunk on stimulation 2 Persistent retrocolis and opisthotonos; crossing or scissoring of arms or legs without spasms of arms/legs and without trismus 3

3. Cry Pattern

Normal 0 High-pitched when aroused 1 Shrill; difficult to console 2 Inconsolable crying; or cry weak/absent 3

4. Altered Gaze

Normal gaze 0 Sun-setting; paralysis of upward gaze 3

Total BIND-M Score

0 / 12

No indication of acute bilirubin encephalopathy

No neurological abnormalities are indicated by the selected findings.

The BIND Score Explained

The BIND score and the subsequent modified BIND-M score evaluate the severity of jaundice-associated acute bilirubin encephalopathy (ABE) in neonates based on clinical neurological signs.

Acute bilirubin encephalopathy is a potentially devastating condition associated with severe neonatal hyperbilirubinaemia. It can result in death or lifelong neurodevelopmental impairment.

      Clinical importance:
      Early recognition of ABE and prompt reduction of bilirubin exposure are
      important. In moderate disease, timely intervention may allow reversal
      of acute neurological dysfunction, while in severe disease it may help
      limit further neurological injury and subsequent sequelae.
    

BIND-M Score Interpretation

BIND-M Score	Interpretation
< 3	No indication of acute bilirubin encephalopathy based on the BIND-M threshold.
≥ 3	Positive BIND-M screen for acute bilirubin encephalopathy. The infant requires urgent clinical assessment and management of hyperbilirubinaemia according to applicable neonatal jaundice guidelines.
Scores of 1-4 are consistent with mild ABE but cannot be differentiated from sepsis or other neonatal illnesses without ancillary testing, such as ABR and/or MRI. Scores 5 to 8 are consistent with moderate ABE Scores ≥ 9 are consistent with severe ABE The BIND score may include different stages for different categories, for example scores of 4 or 5 might represent the sum of one for cry and two for muscle tone and/or arousal state

Important: The BIND-M score is a clinical assessment tool and should not be used in isolation to determine treatment. Clinical assessment, bilirubin concentration, gestational age, postnatal age, risk factors and applicable treatment thresholds should all be considered.

Evidence for BIND-M

In the study evaluating the modified BIND algorithm, 333 paired BIND-M assessments were analysed and demonstrated excellent inter-rater agreement.

A BIND-M score ≥3 was highly predictive of a clinical diagnosis of acute bilirubin encephalopathy, with the following reported diagnostic characteristics:

Measure	Reported value
Sensitivity	90.7%
Specificity	97.7%
Positive predictive value	88.9%
Negative predictive value	98.2%

The study concluded that the modified bilirubin-induced neurologic dysfunction score may be useful for assessing the severity of jaundice and predicting acute bilirubin encephalopathy in neonates, particularly in resource-limited settings.

References

BIND-M

Radmacher PG, Groves FD, Owa JA, Ofovwe GE, Amuabunos EA, Olusanya BO, Slusher TM. A modified Bilirubin-induced neurologic dysfunction (BIND-M) algorithm is useful in evaluating severity of jaundice in a resource-limited setting. BMC Pediatrics. 2015;15:28.

View the BIND-M study on PubMed Central

Clinical disclaimer: This calculator is intended as a clinical decision-support and educational tool. It does not replace clinical assessment, laboratory investigation, local neonatal jaundice treatment protocols, or specialist consultation. A neonate with suspected acute bilirubin encephalopathy requires urgent clinical evaluation and appropriate management.