title: Performing red reflex eye examinations increases the rate of neonatal conjunctivitis.
abstract: OBJECTIVE
  Red reflex eye examinations often require opening the eyelids, risking infection. We evaluated links between this procedure and neonatal conjunctivitis.
  
  
  METHODS
  We divided 18 872 neonates of more than 35 weeks of gestation into two birth periods, 2008-2009 and 2010-2011, before and after red reflex examinations were carried out by our facility. The rates of clinical conjunctivitis, bacterial conjunctivitis and bacterial growth percentage were compared between the two periods.
  
  
  RESULTS
  The 2010-2011 period included more Caesarean deliveries and longer lengths of stay (LOS) than the 2008-2009 period. The clinical conjunctivitis rate increased significantly during 2010-2011 (p = 0.029), but the bacterial conjunctivitis and bacterial growth percentages did not differ between the two periods. Variables that were independently and significantly associated with clinical conjunctivitis included being born in 2010-2011, with an odds ratio (OR) of 1.22, male gender (OR 1.31) and LOS (OR 1.19). Bacterial conjunctivitis was associated with vaginal delivery (OR 3.65), males delivered by Caesarean (OR 2.68) and LOS (OR 1.37).
  
  
  CONCLUSIONS
  Clinical conjunctivitis was significantly associated with the later study period, male gender and LOS. Conjunctival swab sampling increased significantly following the implementation of red reflex examinations, but without changes in the bacterial conjunctivitis rate and the bacterial growth percentage.
authors.affiliation: Department of Neonatology, Rambam Medical Center, Haifa, Israel.|Rappaport Faculty of Medicine, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Technion - Israel Institute of Technology, Haifa, Israel.
authors.forename: Irena
authors.initials: I
authors.lastname: Ulanovsky
authors.affiliation: Department of Neonatology, Rambam Medical Center, Haifa, Israel.|Rappaport Faculty of Medicine, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Technion - Israel Institute of Technology, Haifa, Israel.
authors.forename: Morya
authors.initials: M
authors.lastname: Shnaider
authors.affiliation: Rappaport Faculty of Medicine, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Technion - Israel Institute of Technology, Haifa, Israel.|Department of Clinical Microbiology Laboratory, Rambam Medical Center, Haifa, Israel.
authors.forename: Yuval
authors.initials: Y
authors.lastname: Geffen
authors.affiliation: Department of Neonatology, Rambam Medical Center, Haifa, Israel.|Rappaport Faculty of Medicine, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Technion - Israel Institute of Technology, Haifa, Israel.
authors.forename: Tatiana
authors.initials: T
authors.lastname: Smolkin
authors.affiliation: Department of Epidemiology, Rambam Medical Center, Haifa, Israel.
authors.forename: Tatyana
authors.initials: T
authors.lastname: Mashiach
authors.affiliation: Department of Neonatology, Rambam Medical Center, Haifa, Israel.|Rappaport Faculty of Medicine, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Technion - Israel Institute of Technology, Haifa, Israel.
authors.forename: Shraga
authors.initials: S
authors.lastname: Blazer
authors.affiliation: Department of Neonatology, Rambam Medical Center, Haifa, Israel.|Rappaport Faculty of Medicine, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Technion - Israel Institute of Technology, Haifa, Israel.
authors.forename: Imad R
authors.initials: IR
authors.lastname: Makhoul
mesh_terms: D003231:Conjunctivitis / Q000453:epidemiology / Q000209:etiology*; D003941:Diagnostic Techniques, Ophthalmological / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007557:Israel / Q000453:epidemiology; D008297:Male; D008403:Mass Screening / Q000009:adverse effects; D012189:Retrospective Studies
keywords: Bacterial conjunctivitis; Clinical conjunctivitis; Newborn infant; Red reflex eye examination; Swab sampling