Objective: To determine cumulative incidence of neonatal conjunctivitis (NC) in babies delivered at Mbarara Regional Referral Hospital (MRRH), establish the responsible microorganisms and their sensitivity to available antibiotics and determine factors associated with neonatal conjunctivitis among these babies.
Methods: A prospective cohort study where babies delivered at MRRH whose mothers stayed in Mbarara municipality were recruited within 24 hours after birth and weekly follow up was done until the occurrence of NC, or lost to follow up or administrative censoring at 28 days. Neonates who developed conjunctivitis had a conjunctival swab taken for microbiology.
Results: Out of 438 babies recruited, 45 (10.3%) were lost to follow up while 49 (11.2%, 95% CI 8.4 – 14.5) developed neonatal conjunctivitis by 28 days. Isolated pathogens were Staphylococcus aureus 23 (67.65%), Klebsiella pneumoniae 7 (20.59%), Neisseria gonorrhoeae 3 (8.82%) and Streptococcus pyogenes 1(2.94%). In 15 (30.6%) of 49 cultures done there was no growth. Isolates tested had only 18% sensitivity to tetracycline. However there was 100% sensitivity to gentamycin and oxacillin, while slightly lower sensitivity was achieved for ceftriaxone (76%), ciprofloxacin (68%) and chloramphenical (61%). Not receiving prophylaxis within 24 hours after birth [adjusted OR 4.85 CI (1.17 – 20.19)] and neonatal admission to Neonatal Intensive Care Unit (NICU) after delivery [adjusted OR 6.03 CI (1.09 – 33.32)] were independently associated with higher odds of developing NC.
Conclusions: The incidence of NC was unexpectedly high. Admission to NICU and lack of prophylaxis within 24 hours were risk factors for developing NC.
Key words: Neonatal, Conjunctivitis, Cohort, Incidence
Schaller UC, Klauss V. Is Credé’s prophylaxis for ophthalmia neonatorum still valid? Bull World Health Org. 2001;79(3): 262-266.
Aliraki L, Kagame K, Byarugaba F. The characteristics of infective corneal ulcers as seen at Ruharo Eye Centre. MMed Ophthalmology Dissertation/Thesis, Mbarara University of Science and Technology. Unpublished data 2008.
Chen CJ, Starr CE. Epidemiology of Gram-negative conjunctivitis in neonatal intensive care unit patients. Amer J Ophthal. 2008;145(6):966-70.e2.
Gichuhi S, Bosire R, Mbori-Ngacha D, Gichuhi C, Wamalwa D, Maleche-Obimbo E. Risk factors for neonatal conjunctivitis in babies of HIV-1 infected mothers. Ophthalmic Epidem. 2009;16(6)(6):337-45.
Mundia D, Ilako D, Masinde M. Risk of developing neonatal conjunctivitis in newborns of mothers with prolonged labour. East Afr J Ophthalmol. 2008;14(2):5-12.
Wu J, Liu J, Feng ZC, Huang JJ. Influence of premature rupture of membranes on neonatal health. Zhonghua Er Ke Za Zhi. 2009;47(6): 452-455.
Dogru M, Karakaya H, Baykara M, Ozmen A, Koksal N, Goto E, et al. Tear function and ocular surface findings in premature and term babies. Ophthalmology. 2004; 111(5):901-905.
WHO. Conjunctivitis of the newborn: Prevention and treatment at the primary health care level. Geneva: World Health Organization. 1986.
Isenberg SJ, Apt L, Wood M. A controlled trial of povidone–iodine as prophylaxis against ophthalmia neonatorum. New Engl J Med. 1995; 332(9):562-566.
Tarabishy A, Jeng B. Bacterial conjunctivitis; a review for internists. Cleveland Clinic J Med. 2008; 75:507-512.
Scott LR. Conjunctivitis of the newborn (Ophthalmia Neonatorum). In: David T, Creig HS, editors. Pediatric Ophthalmology and Strabismus. Philadelphia: Elsevier’s Saunders; 2005. p. 146-8.
MOH. Uganda Clinical Guidelines: National Guidelines on Management of Common Conditions. In: Health Mo, editor. 4th ed. Kampala: Ministry of Health; 2010. p. 248 - 9.
CLSI, editor. Perfomance Standards for Antimicrobial Susceptibility Testing; Twenty-First Informational Supplement. CLSI document M100-S21. Wayne, PA: Clinical and Laboratory Standards Institute.2011.
Isenberg SJ, Apt L, Del Signore M, Gichuhi S, Berman NG. A double application approach to ophthalmia neonatorum prophylaxis. Brit J Ophthalmol. 2003; 87(12):1449-52.
Kramer A, Beherens-Baumann W. Prophylactic use of topical anti-infectives in ophthalmology. Ophthalmologica. 1997; 211:68-76.
Darvielle T. Chlamydia trachomatis infections in neonates and young children. Semin Pediat Infect Dis. 2005; 6(4):235.
WHO. Guidelines for management of sexually transmitted infections. 2003:8-9.