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i n s t e i n College of Medicine, Departments of P e d i a t r i c s and Pathology, Bronx, New York.The only c a s e s of K I d e t e c t e d a t autopsy i n neonates a t t h i s i n s t i t u t i o n from 1971 through 1976 occurred i n 3 i n f a n t s with antemortem c u l t u r e proven s e p s i s . During t h i s period t h e r e were 14,210 d e l i v e r i e s , 387 t r a n s f e r r e d -i n b a b i e s , 250 neonatal death and 178 a u t o p s i e s . A l l 3 o f t h e i n f a n t s with K I weighed more tha: 2250 grams and had g e s t a t i o n a l ages of 36 o r 37 weeks. Group B b e t a hemolytic s t r e p t o c o c c a l s e p s i s and m e n i n g i t i s was diagnosed i n one i n f a n t , but t h e baby was never i c t e r i c . The second inf a n t developed K l e b s i e l l a s e p s i s following spontaneous g a s t r i c p e r f o r a t i o n . The peak t o t a l serum b i l i r u b i n c o n c e n t r a t i o n (SBC) i n t h i s baby was 8.6 mg/dl. The t h i r d i n f a n t manifested E . c o l i s e p s i s a t 8 hours of age and d e t e r i o r a t e d d e s p i t e a p p r o p r i a t e a n t i b i o t i c t h e r a p y ; t h e peak t o t a l SBC was 15.6 mg/dl. The d ir e c t -r e a c t i n g SBC i n c a s e s 2 and 3 never exceeded 1 mg/dl. A l l Apgar s c o r e s were a t l e a s t 7 a t 1 minute and 9 a t 5 minutes.During t h i s period of time only 4 c a s e s ( 3 with KI) were locumented i n which s e p s i s was proven p r i o r t o death and a subsequent autopsy was performed. The 3 i n f a n t s with K I a l l d i e d with t h e i r i n f e c t i o n a s t h e primary cause Of death. The i n f a n t without K I , a 32 week 1850 gram baby, d i e d of a massive CNS hemorrhage. This suggests t h a t p e r s i s t a n t b a c t e r i a l s e p s i s may be a c r i t i c a l predisposing f a c t o r i n t h e development o f K I even i n t h e presence of low serum b i l i r u b i n c o n c e n t r a t i o n s . ESTIMATION OF SERUM BILIRUBIN BY SPECTRAL REFLECTANCE1009 10F THE SKIN. Keith J. Peev . L a r r Mumford, Rotert Bruce, and Steven J. GrossSYDuke U i i v e r s i t y M = Center. ~e p a r t m n t s o f Pediatrics and Ophthalmology. Durham, North Carolina (Spon.George W. Brumley). A study w s undertaken t o determine rhether the serum b i l i r ubin l e v e l could be estimated by the l i g h t reflectance o f skin. The reflectance o f s k i n over the abdomen was measured a t f i v e wvelengths ( A = 629. 556. 511. 465. 424). and compared with reflectance o f a uhi t e standard. A formula was derived rhich related measurements o f s k i n reflectance with serum M 1 i r u M n level. T h i r t y Black and 14 Caucasian term infants here then prospectively studied with simul taneous spectral reflectance and serum b i l i r u b i n levels. A l l i n f a n t s here less than one week o f age, and none had received phototherapy. Serum b i l i r u b i n levels ranged from 1 mg/dl t o 12 mg/dl and correlated with spectral reflectance estimates with a c o e f f i c i e n t o f 0.94.Agreeme...

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