Ocular flora in newborns of mothers with premature rupture of membranes, and prolonged labour

Abstract

An analytical case control study was carried out at Kenyatta National Hospital and Pumwani maternity Hospital. The study aimed to determine whether premature rupture of membranes. (PROM), and prolonged labour (PL) increased the rate of exposure of newborn eyes to the maternal vaginal flora and whether the exposure was related to the development of neonatal conjunctivitis. A total of 161 patients were studied between August 2000 and March 2001, amongst whom 52 had PROM, 54 Prolonged Labour and 55 controls. Conjunctival swabs of all the newborns were taken during the first examination, for microscopy, culture and sensitivity. Any signs of conjunctivitis were also noted. HVS was also done during the first contact with the patients. The HVS were performed on 72 mothers and subjected to microscopy, culture and sensitivity. Conjunctival swabs, taken on average, 24 hrs after birth were positive in 63% ofPL, 62% of PROM and 51% of the controls. The rate of transmission of maternal vaginal flora to the eyes of the newborns was found to be 57% in PL, 27% in PROM and 40% in the controls. Conjunctivitis developed in 31% of newborns in PL, 27% in PROM, and 23% in the controls. In general neonatal conjunctivitis developed more frequently in those who had positive ocular cultures and significantly so in the PROM group. Conjunctivitis also developed more frequently in PL group who also showed higher transmission rates than the controls. Staph aureus, Staph epidermidis and E-coli were the most common organisms isolated in the newborn eyes in all the groups. However, whereas Staph species were the commonly transmitted organisms in PL and controls, E-coli was the most common organism in PROM. Staph aureus and epidermidis were resistant to Tetracycline, Kanamycin, and Penicillins. They were sensitive to Ofloxacin, Ciprofloxacin, Gentamycin, Neomycin, Tobramycin, Augmentin, Imipenem, and Cephalosporines. E.coli was resistant to Tetracycline, Penicillin, Erythromycin, and Clindamycin. It was sensitive to Ofloxacin, Ciprofloxacin, Aminoglycosides, Cephalosporins, Chloramphenicol, Vancomycin, and Oxacillin. Conclusions: Neonates, even the high risk ones, did not receive ocular prophylaxis. Prolonged Labour led to higher transmission of maternal vaginal flora to the eyes of newborns. PROM and PL led to higher development of conjunctivitis. The neonates who had positive conjunctival cultures developed conjunctivitis significantly higher than those with negative cultures, in the first month of life.