Risk factors for neonatal conjunctivitis in babies of HIV-1 infected mothers

Abstract

Purpose: To determine the prevalence and correlates of neonatal conjunctivitis in infants born to human immunodeficiency virus type 1 (HIV-1) infected mothers.

Methods: This was a nested case-control study within a perinatal HIV-1 cohort. HIV-1 seropositive mothers were enrolled during pregnancy and mother-infant pairs followed after delivery with assessment for neonatal conjunctivitis at 48 hours and up to 4 weeks after birth. Genital infections (chlamydia, gonorrhea, syphilis, trichomonas, bacterial vaginosis, and candida) were screened for at 32 weeks gestation. Mothers received treatment for genital infections diagnosed during pregnancy and short-course zidovudine. Newborns did not receive ocular prophylaxis at hospital deliveries. Multivariate logistic regression models were used to determine cofactors for neonatal conjunctivitis overall and stratified for infant HIV-1 status.

Results: Four hundred and fifty-two infants were assessed and 101 (22.3%) had neonatal conjunctivitis during the first month postpartum. In multivariate analyses using odds ratios (OR) and confidence intervals (CI), neonatal conjunctivitis was associated with neonatal sepsis (adjusted OR 21.95, 95% CI 1.76, 274.61), birth before arrival to hospital (adjusted OR 13.91, 95% CI 1.39, 138.78) and birth weight (median 3.4 versus 3.3 kilograms, p=0.016, OR 1.79, 95% CI 1.01, 3.15). Infant HIV-1 infection was not associated with conjunctivitis.

Conclusions: Despite detection and treatment of genital infections during pregnancy, neonatal conjunctivitis was frequently diagnosed in infants born to HIV-1 infected mothers suggesting a need for increased vigilance and prophylaxis for conjunctivitis in these infants. Neonatal sepsis, birth before arrival to hospital, and higher birthweight are factors that may predict higher risk of neonatal conjunctivitis in this population.

KEYWORDS::

• Case-control
• HIV
• Maternal
• Neonatal conjunctivitis
• Risk factors

ACKNOWLEDGMENTS

We would like to thank the women and children who participated in this study and the staff at Maternal Child Health Clinics and Kenyatta National Hospital who assisted in study implementation.

Supported by the US National Institutes of Child Health and Disease (NICHD) through grant #RO1 HD-23412. Phelgona Otieno, Carey Farquhar, Dalton Wamalwa, Grace Wariua, and Elizabeth Obimbo were scholars in the AIDS International training and Research Program, NIH Research Grant D43 TW000007, funded by the Fogarty International Center and the Office of Research on Women’s Health.

Declaration of interest: The authors declare no conflict of interest.