Performing red reflex eye examinations increases the rate of neonatal conjunctivitis

Irena Ulanovsky, Morya Shnaider, Yuval Geffen, Tatiana Smolkin, Tatyana Mashiach, Shraga Blazer, Imad R. Makhoul

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


Aim 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). Conclusion 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.

Original languageEnglish
Pages (from-to)e541-e545
JournalActa Paediatrica, International Journal of Paediatrics
Issue number12
StatePublished - 1 Dec 2015
Externally publishedYes

Bibliographical note

Publisher Copyright:
©2015 Foundation Acta Pædiatrica. Published by John Wiley & Sons Ltd.


  • Bacterial conjunctivitis
  • Clinical conjunctivitis
  • Newborn infant
  • Red reflex eye examination
  • Swab sampling


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