Conjunctival flora and conjunctivitis during first 7 days of life in babies born to mothers with prolonged labor: A prospective cohort study

Background:

The neonates are at greater risk of developing conjunctivitis and other eyes infections due to lower levels of lysozyme and Ig A in tears and non development of tear film. Mild and often self limiting bacterial conjunctivitis in newborn babies if not diagnosed and treated properly can lead to eye morbidity of overwhelming consequences.

Objective:

To determine the incidence of conjunctival flora carriage and incidence rate of conjunctivitis in babies born to mothers with prolonged labor.

Methods: Women presenting to deliver in obstetrics wards of two tertiary care hospitals of Karachi were screened for eligibility criteria which included women having singleton baby, with vertex presentation, to be delivered vaginally or only with emergency caesarean section. Women with intrauterine death and non residents of Karachi were excluded. A total of 205 women were recruited in the study. Conjunctival swabs from right eye of new born were taken immediately at birth, and these babies were then followed on day 7 at their homes to observe the development of conjunctivitis.
Results:

Cumulative incidence of conjunctival flora in conjunctival swab was 34% (95%CI: 27.48-40.52%) and most common microorganisms observed were E. coli and Staphylococcus species. Risk of presence of conjunctival flora in babies born to mothers without prolonged labor and those born to mothers with prolonged labor was not different (ARR=1.26 ;95% CI: 0.75-2.14). Presence of microorganisms in gram stain (ARR=4.79; 95%CI: 2.91-7.91); multiparity (ARR=1.83; 95%CI: 1.06-3.16) and receiving antenatal care during pregnancy (ARR=2.23; 95%CI: 0.89-5.55) were significantly associated with risk of having conjunctival flora carriage at birth. Over all incidence rate of conjunctivitis in newborns during first 7 days of life were 12.23 (95% CI: 9.0-16.31) per year.  Hazards of conjunctival infection in babies of mother with prolonged labor was 0.94 (95%CI: 0.41-2.17) during first week of life. Number of vaginal examinations during labor (AHR=1.22; 95%CI: 1.02-1.46), presence of conjunctival flora in conjunctival swab culture (AHR=2.89; 95%CI: 1.10-7.61) and lack of antenatal care during pregnancy (for 4-6 antenatal visits AHR= 4.34; 95% CI: 1.27-14.79 and for less than 4 antenatal visits AHR=5.31 95% CI: 1.37-20.49, as compared to more than 7 antenatal visits) were significantly associated with the development of conjunctivitis in newborn during first week of life.

Conclusions:

Incidence of conjunctival flora carriage and conjunctivitis are high in new born babies of lower and lower middle class of the population but risk is not more in babies of mothers with prolonged labor. However risk of infection can be curtailed by reducing the practice of number of vaginal examination during delivery and encouraging antenatal care during pregnancy.