[Analysis of factors influencing neonatal bacterial flora of the conjunctiva shortly after delivery]. / Analiza czynników okoloporodowych wplywajacych na ksztaltowanie sie flory bakteryjnej worka spojówkowego noworodków.

OBJECTIVES: The aim of this study was the analysis of conjunctival flora in newborns within the first 72 hours of life, depending on the methods of delivery and other perinatal factors. MATERIAL AND METHODS: The study group consisted of 192 mothers and 192 newborns. Culture samples were obtained before delivery from the cervicovaginal secretions of pregnant women and, in case of caesarean sections, additionally from the maternal surface of the fetal membranes. Conjunctival specimens were obtained twice from the inferior conjunctival fornix of the right eye in all the newborns: early sample--immediately after the delivery and late sample--on the third day of neonatal life. Perinatal factors influencing bacterial colonization were analyzed. RESULTS: Statistically significant difference between the four clinical subgroups was found in the interval between the rupture of the membranes and delivery number of obstetrical examinations during delivery antibiotic use during the perinatal period and the presence of green amniotic fluid. Statistically significant difference was observed in the incidence of early sterile samples and method of delivery. The correlation between bacterial species obtained from conjunctival and cervicovaginal secretions samples was also found. The tendency for more frequent occurrence of early sterile samples was observed in newborns of mothers who received antibiotics in the perinatal period and if the interval between the rupture of the membranes and labor was shorter. CONCLUSIONS: The obtained data expanded the knowledge about neonatal conjunctival bacterial flora and demonstrated influence of the perinatal factors on bacterial colonization of the infants' conjunctiva.

[Neonatal conjunctivitis in a hospital at Gran Buenos Aires. Last 5 years up-date]. / Conjuntivitis neonatal en un hospital del Gran Buenos Aires. Situación de los últimos 5 años.

Neonatal conjunctivitis is one of the most important consultation reasons in the first days of life. Causes may be chemical or infectious. Neonatal conjunctivitis study for common microorganisms and Chlamydia trachomatis is being performed at Posadas Hospital since 1995, in a progressive form. The objective of this study was to know the epidemiological situation in the last five years (1999-2003), and to describe the variations detected between two periods, 1995-1998, and 1999-2003. It was observed no change about C. trachomatis prevalence (8%), during all the time in the population studied. With regard to common microorganisms it was showed a decrease in the second period (36.6%) with respect to the first (52.4%). Likely, the causes may be due to changes about sample collection conditions, or to epidemiological variations. The most frequent microorganisms found were: Staphylococcus aureus 69 (27.6%), Streptococcus pneumoniae 68 (27.2%), and Haemophilus influenzae 64 (25.6%). We consider important to evaluate the kind of ocular secretions at the first consultation, which can lead to a symptomatic treatment that will be corroborated or not, according to microbiological results.

Neonatal conjunctivitis: a profile.

Neonatal conjunctivitis is one of the commonest infections encountered in the newborn. A prospective study was conducted on all babies born over a period of one year. No prophylactic ocular medication was instilled routinely in newborns. Babies developing purulent eye discharge were diagnosed to have conjunctivitis. Eye Swab from the neonates and maternal vaginal/cervical swabs were sent for culture. Chloromycetin eye drops were used for treatment and in case of no response, changed as per sensitivity report or to gentamicin eye drops. Oral erthromycin was given for dacryocystitis or when there was no response to topical therapy. The incidence of conjunctivitis was 7.2%. Two seasonal peaks, namely, February and then May and June, were noted. In 91.6% of the babies, conjunctivitis developed within the first week. A prolonged rupture of membranes was associated with a significantly higher incidence of conjunctivitis (p < 0.01). The most common organism grown from conjunctival swab was Staph aureus (35.2%) followed by Enterococcus (4.3%), Klebsiella (3.5%) and E. coli (2.8%). From vaginal/cervical swabs, E. coli was the most common organism isolated. No concurrence of organisms was noted between eye swabs and vaginal/cervical swabs. A uniformly good response to chloromycetin eye drops was noted with only 3.5% requiring a change of therapy. It is concluded that neonatal conjunctivitis is commonly acquired postnatally and responds well to topical chloromycetin therapy. Oral erythromycin may be used in resistant cases which will cover the chlamydial infection also.

Prophylaxis of ophthalmia neonatorum: comparison of silver nitrate, tetracycline, erythromycin and no prophylaxis.

From November, 1989, to October, 1991, 4544 neonates were born at our hospital. Neonatal ocular prophylaxis immediately after birth was used with 1% tetracycline ophthalmic ointment in 1156 neonates, 0.5% erythromycin ophthalmic ointment in 1163 neonates and 1% silver nitrate drops in 1082 neonates. No prophylaxis for neonatal conjunctivitis was given to 1143 neonates. A total of 302 infants (6.7%) developed conjunctivitis during the first 4 weeks of life. Between December, 1991, and January, 1992, 425 neonates were born at our hospital and all were given 0.5% erythromycin ophthalmic ointment twice in the first 24 hours after birth for ocular prophylaxis. Thirty-one (7.3%) infants developed conjunctivitis during the neonatal period. The incidence rates of neonatal chlamydial conjuctivitis in the tetracycline, erythromycin, silver nitrate, no prophylaxis and erythromycin twice groups were 1.3, 1.5, 1.7, 1.6 and 1.4%, respectively. We conclude that neonatal ocular prophylaxis with erythromycin (one or two doses) or tetracycline or silver nitrate does not significantly reduce the incidence of neonatal chlamydial conjunctivitis compared with that in those given no prophylaxis.

Clinical and bacteriological study of normal and inflamed neonatal conjunctivae.

Maternal vaginal and neonatal conjunctival flora were prospectively studied in a 117 mother baby pairs. The commonest isolates from both vaginal and conjunctival flora were E. coli, Staphylococcus aureus and Klebsiella species. In 85% of mother-baby dyads, isolates from vagina and conjunctiva were similar. The commonest bacterial isolates in neonates with conjunctivitis were Staphylococcus aureus (37.4%), E. coli (27.9%) and Klebsiella species (19.3%). Maternal coitus, infections, rupture of membranes and baby's birth weight and sex did not influence the occurrence of conjunctivitis.