1008 THE ASSOCIATION OF KERNICTERUS (KI) WITH BACTERIAL SEPSIS

Abstract

The only cases of KI detected at autopsy in neonates at this institution from 1971 through 1976 occurred in 3 infants with antemortem culture proven sepsis. During this period there were 14,210 deliveries, 387 transferred-in babies, 250 neonatal deaths and 178 autopsies. All 3 of the infants with KI weighed more than 2250 grams and had gestational ages of 36 or 37 weeks. Group B beta hemolytic streptococcal sepsis and meningitis was diagnosed in one infant, but the baby was never icteric. The second infant developed Klebsiella sepsis following spontaneous gastric perforation. The peak total serum bilirubin concentration (SBC) in this baby was 8.6 mg/dl. The third infant manifested E.coli sepsis at 8 hours of age and deteriorated despite appropriate antibiotic therapy; the peak total SBC was 15.6 mg/dl. The direct-reacting SBC in cases 2 and 3 never exceeded 1 mg/dl. All Apgar scores were at least 7 at 1 minute and 9 at 5 minutes. During this period of time only 4 cases (3 with KI) were documented in which sepsis was proven prior to death and a subsequent autopsy was performed. The 3 infants with KI all died with their infection as the primary cause of death. The infant without KI, a 32 week 1850 gram baby, died of a massive CNS hemorrhage. This suggests that persistant bacterial sepsis may be a critical predisposing factor in the development of KI even in the presence of low serum bilirubin concentrations.