gms | German Medical Science

Although infective conjunctivitis has been shown to be the most common infection in the newborn, controversy still reigns on whom, when and how to institute ocular prophylaxis. Prolonged labour has been shown to increase neonatal sepsis. Few, if any studies have looked into this factor and its role in neonatal conjunctivitis. The data obtained is hoped to serve as a basis for selective prophylaxis in situations of scarce resources. An analytical case control study was carried out at Kenyatta National Hospital and Pumwani Maternity Hospital between August 2000 and March 2001. The aim was to determine whether prolonged labour (PL) increased the rate of exposure of newborn eyes to the maternal vaginal flora, and whether such exposure was related to the development of neonatal conjunctivitis.

The study looked at 54 patients with prolonged labour (active labour more than 12hrs) and 55 controls. During the first contact with the patients, the newborns were examined for signs of conjunctivitis and the relevant demographic data taken and the questionnaire completed. Conjunctival swabs for microscopy, culture and sensitivity were taken from all the newborns. High vaginal swabs were taken from 23 mothers in the prolonged labour group and 19 of the controls. The swabs were taken, on average, 24hrs after birth.

The conjunctival cultures were positive in 63% of newborns in the PL group and 51% of the controls (odds ratio 1.9, p-value 0.09). The transmission rates of maternal vaginal flora to the newborn eyes were 57% in PL and 40% in the control (odds ratio 1.95, p-value 0.027). Conjunctivitis developed in 31% of newborns in PL and 23% of the controls (odds ratio 1.6, p-value 0.26). Conjunctivitis developed more frequently in those from whom positive conjunctival cultures had been obtained. Ocular prophylaxis was only given to less than 2% of the newborns. The most common organisms isolated from the two groups were similar and included, Staph aureus, Staph epidermidis, Strep pneumonia and Escherichia coli. They were sensitive to the flouroquinolones, cephalosporines and aminoglycosides. They were highly resistant to Tetracycline, Penicillin, and notably Kanamycin.

No ocular prophylaxis was given, even for the high-risk group of newborns. Prolonged labour led to a higher transmission of maternal vaginal flora to the eyes of the newborns, which, subsequently, led to higher rate of conjunctivitis.