Ophthalmia Neonatorum Research Articles

Evaluation of preventive effects of colostrum against neonatal conjunctivitis: A randomized clinical trial.

Background:Neonatal conjunctivitis leads to several ocular consequences in the affected neonates such as blindness. Currently available therapeutic options include NaNO3, Gentamicin, Neomycin and so on, in which each of them has their own limitations. Regarding the immunologic content of colostrum and its safety and easy accessibility, we aimed to evaluate its preventive effects against neonatal conjunctivitis.Materials and Methods:In this clinical trial, conducted from November 2011 to July 2012, 300 preterm neonates, with culture negative eye swab, were enrolled and randomly assigned into three groups. The intervention group received two drops of colostrum. Control group received no treatment and other neonates were treated with topical Erythromycin ointment (0.5%). All neonates were followed for occurrence of clinical conjunctivitis for 28 days. Data analysis were performed by Chi-square test.Results:Our data demonstrate the beneficial preventive effects of Colostrum against neonatal conjunctivitis (P = 0.036).Conclusion:Colostrum is suggested as an alternative prophylactic option for antibiotics against neonatal conjunctivitis. As colostrum is easily accessible without cost, potential hazards and side effects, public education about its topical favorable effects is worthwhile.

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

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.

Chlamydia trachomatis related knowledge and practices in medical practioners--a survey.

Chlamydia trachomatis is a frequently encountered condition by general physicians, urologists and infectious diseases specialists. It can affect both genders and causes significant morbidity if not treated properly and promptly. In addition, it can cause ophthalmia neonatorum, which manifests as neonatal conjunctivitis in the newborns. The data was collected from fourteen tertiary care hospitals in two provinces of Pakistan during the time period of four months (September-December 2013). Inclusion criteria included all medical practitioners working at those hospitals and there were no limitations of age and gender to participate. The participants were approached through email which included a self administered questionnaire. Written consent was obtained from the participants and the study was approved by the ethical committee of all selected hospital. Overall 130 participants participated with a response rate of 65%. Females were 52.3% and males were 47.7%. In the study 17.7% of male and 29.4% of female participants proclaimed that they referred a patient to an infectious disease specialist in case the diagnosis of Chlamydia was dubious. 72.5% of the male and 55.8% of the female medical practitioners indicated that they yield detailed sexual history from the patients with Chlamydia. Regarding inquiring about the drugs history from the patient at risk of STDs, 22.6% male and 35.3% of female participants informed that they took a detailed drug history. Only 1.5% of the female medical practitioners notified Chlamydia to the partner of diseased patient themselves (provider referral). 24% male and 17.6% female participants had an understanding regarding the definite test of diagnosis for sexually transmitted Chlamydia. More sexual health skills development is required in medical practitioners working in Pakistan. The major deficient areas are sexual and drug history taking, management of sexually transmitted diseases and partner notification.

'Scientific Truth into Homely Language': The Training and Practice of Midwives in Ophthalmia Neonatorum, 1895-1914

Ophthalmia neonatorum, a form of neonatal conjunctivitis, was seen to be a serious problem in England at the turn of the twentieth century. Midwives were directly implicated in its prevalencewith debate ensuing over the extent towhich they should be taught about ophthalmia neonatorumand the extent towhich they should participate in the diagnostic and therapeutic process. The involvement of midwives in cases of ophthalmia neonatorum has received little attention from historians. Yet it constitutes an important case study for the limitations in theoretical knowledge available to midwives, andfor theprofessionalanddisciplinaryboundaries imposeduponmidwiferypractice following the passing of theMidwives Act in 1902 and the establishment of the CentralMidwives Board. This article addresses the training of midwives in ophthalmia neonatorum and the ways in which midwives were able to utilise such training in their professional practice.

Health system support for childbirth care in Southern Tanzania: results from a health facility census.

BackgroundProgress towards reaching Millennium Development Goals four (child health) and five (maternal health) is lagging behind, particularly in sub-Saharan Africa, despite increasing efforts to scale up high impact interventions. Increasing the proportion of birth attended by a skilled attendant is a main indicator of progress, but not much is known about the quality of childbirth care delivered by these skilled attendants. With a view to reducing maternal mortality through health systems improvement we describe the care routinely offered in childbirth at dispensaries, health centres and hospitals in five districts in rural Southern Tanzania. We use data from a health facility census assessing 159 facilities in five districts in early 2009. A structural and operational assessment was undertaken based on staff reports using a modular questionnaire assessing staffing, work load, equipment and supplies as well as interventions routinely implemented during childbirth.ResultsHealth centres and dispensaries attended a median of eight and four deliveries every month respectively. Dispensaries had a median of 2.5 (IQR 2–3) health workers including auxiliary staff instead of the recommended four clinical officer and certified nurses. Only 28% of first-line facilities (dispensaries and health centres) reported offering active management in the third stage of labour (AMTSL). Essential childbirth care comprising eight interventions including AMTSL, infection prevention, partograph use including foetal monitoring and newborn care including early breastfeeding, thermal care at birth and prevention of ophthalmia neonatorum was offered by 5% of dispensaries, 38% of health centres and 50% of hospitals consistently. No first-line facility had provided all signal functions for emergency obstetric complications in the previous six months.ConclusionsEssential interventions for childbirth care are not routinely implemented in first-line facilities or hospitals. Dispensaries have both low staffing and low caseload which constrains the ability to provide high-quality childbirth care. Improvements in quality of care are essential so that women delivering in facility receive “skilled attendance” and adequate care for common obstetric complications such as post-partum haemorrhage.

Bacterial agents and sensitivity pattern of neonatal conjuctivitis in Aminu Kano Teaching Hospital

Introduction : In Africa alone, between 1000 – 4000 children are blinded annually by conjunctivitis. In view of the changing aetiological agents documented in other parts of the world and evolving resistance of infective agents to therapeutic agents, the present study was designed to define the bacterial agents, their antibiotic sensitivity pattern seen in AKTH, Kano, Nigeria. Patients and methods : This was a cross sectional prospective study done over a period of 3 months. Consecutive neonates who satisfied the inclusion criteria were recruited until the sample size of 175 was obtained. samples were transported to the laboratory within one hour. Gram staining and antibiotic sensitivity were determined using standard technique. Results : The mean age at presentation was 5.7 ± 4.6days. Results of the eye swabs showed that 97 (55.4%) were bacteriologically positive while 78 (44.6%) yielded no growth. Staphylococcus aureus was the most frequently isolated organism and was most sensitive to ceftriaxone, (73.1%). Escherichia coli was most sensitive to gentamicin (78.3%). Pseudomonas aeruginosa and Neisseria gonorrhea showed 100% sensitivity to ceftazidime and ceftriaxone respectively. Conclusion : Staphylococcus aureus is the commonest bacterial agent responsible for neonatal conjunctivitis. Staphylococcus aureus was most sensitive to ceftriaxone. Key words : Conjuctivitis, Neonates, Bacteria, Sensitivity.

A microbiological study of neonatal conjunctivitis in two hospitals in Tehran, Iran

ObjectiveTo determine the prevalence of neonatal conjunctivitis and to identify the causative agents of ophthalmia neonatorum in two university affiliated hospitals from 2008 to 2009. MethodsAll neonates admitted in the neonatal department during the study period were examined for the presence of conjunctivitis. Two swab specimens containing epithelial cells of the conjunctiva were collected from newborns presenting with conjuntival inflammation. Laboratory diagnosis was based on direct smear for Gramstaining and bacterial culture. The isolated bacteria were identified using standard procedures. PCR and cell culture were used for identification. Results: Of the 2 253 neonates, (age ranged 1-30 days), clinical findings of conjunctivitis were found in 241 cases (10.7%). The most commonly isolated bacteria were Coagulase negative staphylococci(n=130, 53.9%); Chlamydia trachomatis was the second most common cause of acute neonatal conjunctivitis (n=40, 16.6%). Bacterial cultures were negative in 47 neonates (19.5%) despite clinical signs of conjunctivitis. The median age at presentation for bacterial culture positive was day 8 of life. ConclusionsNeonatal conjunctivitis is prevalent in newborns; Gram positive cocci and Chlamydia trachomatis are the most common causative organisms.

Role of Paediatricians in Paediatric Ophthalmology

Children are primarily examined by paediatricians. In Nepal, child health is in low priority due to illiteracy, there is total lack of awareness about children’s eye health. The common avoidable causes of childhood blindness are refractive errors, amblyopia, retinopathy of prematurity (ROP), vitamin A deficiency (VAD), xerophthalmia, ophthalmia neonatorum (ON), congenital cataract, and retinoblastoma. Paediatricians could be the key persons for early referral of these children to a paediatric ophthalmologist. Paediatricians can send the patients for eye examination after birth within 6 weeks, at 6 months, at one year and before going to school. In conclusion, early screening and referral by the paediatricians to the paediatric ophthalmologist prevents children from being sightless. DOI: http://dx.doi.org/10.3126/jnps.v33i1.7605 J Nepal Paediatr Soc. 2013;33(1):80-82

Gonococcal Infections

Gonococcal Infections

Gonococcal Infections

Gonococcal Infections

A Study on Sexually Transmitted Diseases in Kirkuk City

Objective: The study was planned to show the prevalence of sexually transmitted disease (STD) among women and neonates attending some private clinics in Kirkuk City. Patients and methods: A cross sectional study was performed on 425 women and neonates attended private clinics in Kirkuk city. The period of study was from 1 st of January 2004 to 31 st of December 2004. Results: It was found that the highest rate of symptoms was vaginal discharges followed by lower abdominal pain, genital ulcers, ophthalmia neonatorum and inguinal bubo respectively. Patients with more than one symptom were also detected. Among patients with discharge, Candida albicans (53.42%) and Trichomonas vaginalis (80.82%) were observed. In addition to symptoms, several genital problems were seen, such as Molluscum contagiosum, warts, Herpes simplex and Tenia cruris. The VDRL positive cases were detected among patients enrolled the study. Conclusion: The prevalence of STD symptoms is common among patients attending the private clinics. The highest rate of symptoms was vaginal discharge followed by lower abdominal pain and genital ulcers. More than one symptoms was detected among patients in the studied groups. Several genital problems were found in association with STD symptoms.

Maternal risk factors for neonatal conjunctivitis in Aminu Kano Teaching Hospital, Kano, Nigeria

Background: Neonatal conjunctivitis remains a major cause of preventable childhood blindness in developing countries. There are maternal risk factors, which if identified can assist in its prevention. Objective: This study attempts to determine the maternal risk factors for the development of neonatal conjunctivitis among babies seen in a tertiary health facility in Kano, Nigeria. Materials and Methods: This was a cross-sectional study. Neonates from special care baby unit, postnatal ward, paediatric out-patient unit and labour room who had bilateral or unilateral eye discharge were enrolled in the study. Those neonates whose parents refused consent were excluded from the study. The questionnaire sorted for information including patients' biodata, place and mode of delivery, age at onset of eye discharge, mothers' biodata, antenatal care attendance, educational and socioeconomic status and obstetrics history. Samples were collected and Gram staining was conducted using standard technique. Chlamydial antigens were detected using a rapid immunochromatographic technique (ICT). The data were analysed using EPI INFO version 3.5.1 2002. Proportions were compared using Chi-square test of significance. A probability ( P - value) of less than 0.05 was considered statistically significant. Results: A total of 175 neonates were studied. The mean age was 5.7 ± 4.6 days with a male:female ratio of 1.1:1. Low level of maternal education, lack of antenatal care attendance, prolonged rupture of amniotic membranes and low socioeconomic status were significantly associated with isolate positive neonatal conjunctivitis. Conclusion: Maternal factors including lack of antenatal care attendance and poor socioeconomic conditions are significantly associated with isolate positive neonatal conjunctivitis.

Ophthalmia neonatorum: a modern problem

Ophthalmia neonatorum is conjunctivitis that occurs in the first 28 days of life and is strongly associated with sexually transmitted disease particularly gonorrhoea and chlamydia. The incidence of sexually transmitted disease globally remains high and in the industrialized countries is increasing despite public health interventions. Ophthalmia neonatorum can cause permanent damage to the eye and can lead to associated serious disease and it is therefore important that healthcare professionals observe for and diagnose the condition promptly. Preventative measures have some value particularly in developing countries.

Trajectoire scientifique des points clés de l’effet du stress sur l’immunité

To determine the prevalence of neonatal conjunctivitis and to identify the causative agents of ophthalmia neonatorum in two university affiliated hospitals from 2008 to 2009.All neonates admitted in the neonatal department during the study period were examined for the presence of conjunctivitis. Two swab specimens containing epithelial cells of the conjunctiva were collected from newborns presenting with conjuntival inflammation. Laboratory diagnosis was based on direct smear for Gramstaining and bacterial culture. The isolated bacteria were identified using standard procedures. PCR and cell culture were used for identification. Results: Of the 2 253 neonates, (age ranged 1-30 days), clinical findings of conjunctivitis were found in 241 cases (10.7%). The most commonly isolated bacteria were Coagulase negative staphylococci(n=130, 53.9%); Chlamydia trachomatis was the second most common cause of acute neonatal conjunctivitis (n=40, 16.6%). Bacterial cultures were negative in 47 neonates (19.5%) despite clinical signs of conjunctivitis. The median age at presentation for bacterial culture positive was day 8 of life.Neonatal conjunctivitis is prevalent in newborns; Gram positive cocci and Chlamydia trachomatis are the most common causative organisms.

A microbiological study of neonatal conjunctivitis in two hospitals in Tehran, Iran

Methods and materials All neonates admitted in the neonatal department during the study period were examined for the presence of conjunctivitis. Two swab specimens containing epithelial cells of the conjunctiva were collected from newborns presenting with conjuntival inflammation. Laboratory diagnosis was based on bacterial culture and Gram staining. The isolated bacteria were identified using standard procedures. For identifying Chlamydia trachomatis we used PCR and cell culture.

Managing Sexually Transmitted Infections in Pregnant Women

Sexually transmitted infections (STIs) constitute a major public health problem in the UK and may result in very costly complications. Many STIs pose the risk of a number of adverse pregnancy outcomes including miscarriage, still birth, preterm delivery, low birth weight and ophthalmia neonatorum. National guidelines for the management of STIs are produced and regularly revised by the British Association of Sexual Heath and HIV. This review outlines the latest recommended treatment options during pregnancy for the commonly encountered STIs.

Ophthalmia Neonatorum: A Letter to Editor

Neonatal Conjunctivitis, also known as Ophthalmia Neonatorum, is a form of bacterial conjunctivitis contracted by newborn during delivery. It is a rare clinical entity in advanced countries, but relatively common in developing countries. Many bacteria and viruses can cause conjunctivitis in the neonates. Two most feared causes are Neisseria gonorrhoeae and Chlamydia trachomatis acquired from birth canal during delivery. We present a case of gonococcal Ophthalmia Neonatorum in a 20 days young neonate from mid-western (Myagdi), Nepal.DOI: http://dx.doi.org/10.3126/ajms.v2i3.5237Asian Journal of Medical Sciences 2 (2011) 72-78

Que reste-t-il aujourd’hui des conjonctivites néonatales dans la préfecture de la Kozah au Togo ?

The purpose of this study is to screen the neonatal conjunctivitis in order to evaluate its incidence and especially to seek for the causative germs. We have realized cross-sectional study in three health centers of the prefecture of Kozah from March 24 to May 12, 2009. All the newborns followed in these centers are examined in the search of signs of conjunctivitis. A biological diagnosis of conjunctival secretions was carried out at the suspect newborns. During the study period, 348 newborns were examined including 185 boys and 163 girls corresponding to a sex-ratio (M/F) of 1.1. The middle age was 3.7 days. Twenty-eight newborns presented conjunctivitis, that is to say a rate of incidence of 8%. The cases of conjunctivitis were observed the first four days of life in 39.3% of cases. Eighteen of the newborns presenting conjunctivitis were vaginal deliveries (64.3%) against ten (35.7%) by caesarian. All the mothers of the ill newborns had a syndrome of sexually transmissible infection (STI) during the third quarters of pregnancy. After biological diagnosis, Staphylococcus aureus was found in 25% of the cases. Despite the common herd of neonatal conjunctivitis prophylaxis by Crede's method, its remains in the prefecture of Kozah. In hope for neonatal conjunctivitis eradication, treatment of STI on pregnant women associated to education and communication on the prevention of the infection in neonatal health care centers and at home by hygiene rule application are necessary.

Female genital Chlamydia trachomatis infection: where are we heading?

Urogenital infection by Chlamydia trachomatis is the most common bacterial sexually transmitted disease in the world. C. trachomatis is the etiologic agent of several common genital tract syndromes such as urethritis, cervicitis, and pelvic inflammatory disease in women. In this review, the pathophysiology of a chlamydial infection as well as diagnosis, therapy and prevention strategies regarding female chlamydial infection are reviewed. A chlamydial infection results in minimal or even no symptoms in approximately two-thirds of women, remaining therefore clinically apparent and undiagnosed. C. trachomatis infections are of great socioeconomic and public health concern due to the potential for severe long-term consequences in women, including an increased risk of ectopic pregnancy, tubal infertility and chronic pelvic pain. Moreover, if the bacterium is transmitted during labor to a newborn, it can cause ophthalmia neonatorum and atypical neonatal pneumonia. Due to the documented increased risk of morbidity, several national guidelines are available, including a routine screening for young women and screening during pregnancy that is recommended in several countries. A routine screening for young women and screening during pregnancy is recommended in several countries. However, additional prospective studies of the effectiveness of chlamydia screening are warranted and might be feasible within established screening programs. Moreover, the transition from cervicitis to infertility should be also evaluated in future controlled studies to underline the existing evidence. Additionally, there is an urgent need to educate and inform health-care providers about implementation of screening programs to reduce the spread of chlamydial infection. Moreover, awareness and use of screening programs by the public is needed, which requires informational campaigns for the general public using different media. For improved screening strategies and public awareness, novel approaches have to be developed and evaluated. Finally, guidelines should be actively disseminated to all medical practitioners to increase their use in daily practice. Although the major socioeconomic and public health concerns of C. trachomatis infection are recognized, several considerations and additional measures for addressing this increasingly urgent health problem remain.

Trichomonas vaginalis Associated with Adverse Pregnancy Outcomes: Implications for Maternal Health Care Delivery System in South Eastern Nigeria

Pregnant women infected with Trichomonas vaginalis are often untreated and evidence from the biology and epidemiology of the organism suggests that it may play an important role in causing adverse pregnancy outcomes. Using high vaginal swab from consenting pregnant women, a follow-up hospital based survey of T. vaginalis infection and its effect on pregnancy outcome among pregnant women attending antenatal clinics was conducted. Pregnancy outcome was determined on the basis of delivery before 37 weeks of gestation (according to general standards), low birth weight infants and neonatal conjunctivitis. The presence of T. vaginalis was re-examined at the point of delivery to exclude treated cases of infection during gestation period. Of the 688 pregnant women who gave birth within the study period, 89(12.9%) were positive for T. vaginalis with 31(19.38%) of the positive patients having pre-term delivery. Also, of the total of 89 infants from the infected mothers, 21(24.14%) had low birth weight of below 2.5 Kg, while 31(18.8%) had conjunctivitis. The result shows that the infection of T. vaginalis during