Aetiology of conjunctivitis in Sebokeng hospital neonates who received routine prophylaxis at birth against eye infection

Thomas, Cherian
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Neonatal conjunctivitis remains an important cause o f morbidity, particularly in developing countries, despite the widespread use of antibacterial prophylaxis. Objectives 1. To establish the aetiology o f conjunctivitis among Sebokeng neonates. 2. To assess the efficacy o f the prophylaxis used at Sebokeng Hospital. 3. To propose an effective prophylaxis and treatment protocol for neonatal ophthalmia based on the study results. M ethod A prospective, observational study was carried out at Sebokeng Hospital, Gauteng. Hospital-born neonates presenting with conjunctivitis, between 0 - 3 0 days, who had routine prophylaxis (10% Spersamide) at birth were studied. . In addition, 10 home bom infants who did not receive prophylaxis and presented with neonatal conjunctivitis were also studied. The study was conducted over a 8 month period (November 1995- July 1996) Tw o eye swabs were collected from each neonate, one for routine culture and susceptibility tests and the other for chlamydial culture. Results were statistically analysed using Chi-squared contingency table tests. Mothers o f affected infants were interviewed about the course o f their pregnancy and about possible predisposing factors for their infant’s illness. Results In the 105 hospital bora infants with neonatal conjunctivitis, the commonest pathogenic organisms isolated were Staphylococcus aureus in 23.8%, Chlamydia trachomatis in 12.4%, Neisr eria gonorrhoeae in 11.4% and Streptococcus pneumoniae in 9.5%. Gram negative bacilli were found in a total o f 22 (20.9%) patients, the commonest being Klebsiella pneumoniae The incidence o f ophthalmia neonatorum was 3.66 cases per 100 live births; that o f chlamydia 0.45 cases per 100 live births and the gonorrhoeae rate was 0.41 cases per 100 live births. Though Spersamide (10% sulphacetamide) eye drops appeared to function adequately as a prophylactic agent, its efficacy in treating N, gonorrhoeae. S, aureus and C trachomatis were inadequate. An overall 96% sensitivity rate to Chloramphenicol was shown by the commonest pathogenic organisms. Home-born babies who did not receive any prophylaxis showed a higher rate o f gonococcal and S. aureus infection rate (30% each) than hospital bora babies. However, this was not statistically significant owing to the small number o f neonates in this subset (10 neonates). Only 25 (20%) mothers were married. A history o f vaginal discharge was present in 78% o f mothers, 68% of whom received some form of treatment antenatally. Conclusions S. aureus emerged as the most common cause o f eye infection among Sebokeng Hospital bom neonates followed by C. trachomatis and N . gonorrhoeae. Spersamide 10% eye drops was found to be inadequate as a prophylatic agent against eye infection. It is recommended that it should be replaced immediately by chloramphenicol eye drops or eye ointment. Recommendations are also provided on the optimal management o f established neonatal conjunctivitis.