title: Risk factors for neonatal conjunctivitis in babies of HIV-1 infected mothers.
abstract: OBJECTIVE
  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.
authors.affiliation: Departments of Ophthalmology, University of Nairobi, Kenya. sgichuhi@uonbi.ac.ke
authors.forename: Stephen
authors.initials: S
authors.lastname: Gichuhi
authors.forename: Rose
authors.initials: R
authors.lastname: Bosire
authors.forename: Dorothy
authors.initials: D
authors.lastname: Mbori-Ngacha
authors.forename: Christine
authors.initials: C
authors.lastname: Gichuhi
authors.forename: Dalton
authors.initials: D
authors.lastname: Wamalwa
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Maleche-Obimbo
authors.forename: Carey
authors.initials: C
authors.lastname: Farquhar
authors.forename: Grace
authors.initials: G
authors.lastname: Wariua
authors.forename: Phelgona
authors.initials: P
authors.lastname: Otieno
authors.forename: Grace C
authors.initials: GC
authors.lastname: John-Stewart
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D016022:Case-Control Studies; D003231:Conjunctivitis / Q000453:epidemiology*; D005260:Female; D005865:Gestational Age; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology*; D015497:HIV-1; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000453:epidemiology*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious; D015995:Prevalence; D012307:Risk Factors; D055815:Young Adult; D015215:Zidovudine / Q000627:therapeutic use
chemical_list: D000998:Antiviral Agents; D015215:Zidovudine