Maternal and neonatal risk factors associated with vertical transmission of ophthalmia neonatorum in neonates receiving health care in Blantyre, Malawi

Abstract

Context:Neonatal conjunctivitis is associated with poor prenatal care worldwide.Purpose:Data on neonatal conjunctivitis is scarce in Malawi. This study describes risk factors associated with conjunctivitis in neonates born in a large tertiary care hospital in Blantyre, Malawi.Materials and Methods:Medical records of a retrospective cohort of 231 neonates diagnosed with conjunctivitis from January 2006 to December 2009 at a large tertiary hospital in Malawi were reviewed. All subjects were clinically diagnosed with ophthalmia neonatorum. Data were collected on patient demographics and clinical features. The frequencies were calculated of various risk factors in neonates with ophthalmia neonatorum and their mothers as well as the treatments administered.Results:Mean age of the mother was 23.45 years (range, 15-40 years), and the mean number of previous deliveries was 2.3 (range, 1-7) children. Nearly, 80% of mothers delivered preterm infants via spontaneous vaginal delivery. The mean birth weight of neonates was 2869.6 grams (1100-5000 grams). Among mothers, premature rupture of membranes was the leading risk factor (24%) followed by sepsis during labor (9%), and history of sexually transmitted infections (STI) (7%). Neonates presented with low Apgar scores (19%), fever (8%), and/or meconium aspiration (5%). Providers treated patients empirically with a varied combination of benzyl penicillin, gentamicin, tetracycline eye ointment, and saline eye wash. Tetracycline with a saline eyewash was used frequently (34%) compared with combinations of benzyl penicillin and gentamicin.Conclusions:Improving prenatal care to reduce sepsis, traumatic deliveries, and early diagnosis of STI with appropriate treatment may potentially reduce vertical transmission of neonatal conjunctivitis in this understudied population.

Response to maternal and neonatal risk factors associated with vertical transmission of ophthalmia neonatorum in neonates receiving health care in Blantyre, Malawi

“…In response to the letter to the editor regarding the publication written by Ranjit et al . 1 thank you for your comments. I would like to clarify a few of the aforementioned points in the letter.…”

Maternal and neonatal risk factors associated with vertical transmission of ophthalmia neonatorum in neonates receiving health care in Blantyre, Malawi

“…I have two comments on the interesting study by Ranjit et al . 1 First, Msukwa et al . 1 addressed the frequency distribution of various maternal risk factors (premature rupture of membranes [24%], sepsis during labor [9%], and history of sexually transmitted infections [STIs] [7%]) and neonatal risk factors (low Apgar scores [19%], fever [8%], and/or meconium aspiration [5%]) associated with ophthalmia neonatorum (ON) among their study of neonates.…”

Oftalmia Neonatal-Profilaxis con Povidona Iodada y Agentes de Transmissión Vertical: estudio intervencional en dos Unidades Materno-Infantiles en Luanda

“…También se debe hacer el tratamiento a los padres con tetraciclina o eritromicina durante un período de dos semanas 2 b) La insuficiente cobertura de la atención primaria de la salud incluyendo la atención prenatal 16,33,47 . c) La ausencia de programas rutinarios de profilaxis de la ON 5,7,33,47,48 .…”

“…La RPM es la pérdida espontánea de líquido del saco amniótico a través de la ruptura de la bolsa que puede ocurrir a partir de 28 semanas de gestación hasta una hora antes del inicio del parto. En el parto a término la RPM se refiere a la ruptura de la membrana fetal antes del inicio del parto y se asocia con varias complicaciones incluyendo un mayor riesgo de infección del feto y el útero por el paso de bacterias en el canal vaginal y en el cuello uterino para el interior del útero 48,60,61,62 .…”

“…Las principales objeciones al uso de la P-I son debidas al hecho de que se puede confundir con la formulación detergente y de acuerdo con algunos autores, la conjuntivitis química causada por P-I puede facilitar la infección conjuntival por otros agentes 4,28,29,33 . Esta situación es similar a lo que ocurre en los países más subdesarrollados muchos de los cuales se encuentran en África 13,15,16,47,48 .…”