OBJECTIVE
To describe the incidence and clinical characteristics of conjunctivitis in the first year of life.
DESIGN
Population-based cohort study.
PARTICIPANTS
All infant (≤12 months of age) residents of Olmsted County, Minnesota, diagnosed with conjunctivitis from January 1, 2005, through December 31, 2014.
METHODS
The medical records of all potential cases identified by the Rochester Epidemiology Project database were reviewed.
MAIN OUTCOME MEASURES
Incidence rate and clinical features of infantile conjunctivitis.
RESULTS
A total of 2175 infants were diagnosed during the 10-year period, yielding an incidence of 10,422 per 100,000 children or approximately 1 in 10 infants by 1 year of age. The mean age at diagnosis was 4.9 months (range, 1 day–12 months), and 1001 (46.0%) were female. Both eyes were involved in 1180 (54.3%), the right eye alone in 506 (23.3%), and 489 (22.5%) in the left. Five hundred seventy-six (26.5%) of the 2175 were diagnosed at ≤30 days of life, from which topical cultures were obtained in 111 (19.7%). Only 36 (32.4%) of the cultures showed bacterial agents, with Chlamydia present in 3. Treatment for infantile conjunctivitis, where recorded, included topical antibiotics in 523 (90.8%) and simple observation in 47 (8.2%).
CONCLUSIONS
Conjunctivitis in the first year of life occurred in approximately 10% of infants in this population-based cohort. More than half involved both eyes, one-quarter were identified in the first 30 days of life, and sight-threatening infectious agents were rare.
C onjunctivitis is a common ocular condition among infants, generally characterized by injection of the conjunctival vessels with or without discharge. The causes are diverse and include chemical, allergic, bacterial, or viral and may be acute or chronic. Without a timely diagnosis and subsequent treatment, conjunctivitis can result in ocular complications and disseminated infection. , Although there are numerous studies concerning the bacterial pathogens in neonatal conjunctivitis, there are few reports on the incidence and clinical features of conjunctivitis in the first year of life. The purpose of this study is to describe the incidence and clinical characteristics of infantile conjunctivitis diagnosed over a 10-year period in Olmsted County, Minnesota.
METHODS
STUDY POPULATION
The medical records of all patients ≤12 months of age diagnosed with any type of conjunctivitis while residing in Olmsted County, Minnesota, from January 1, 2005, through December 31, 2014, were retrospectively reviewed. Olmsted County is located 145 km (90 miles) southeast of Minneapolis. Approximately 70% of the county’s residents (124,277) lived within the Rochester city limits in 2000. The racial demographic of Olmsted Country residents was 82.0% Caucasian, 3.7% Asian, 3.2% Black or African American, 0.3% Native American or Alaska Native, 2.6% for other, and 7.6% for unknown. Hispanic or Latinos of any race accounted for 2.4% of the population.
CASE ASCERTAINMENT AND DIAGNOSTIC CRITERIA
Mayo Clinic and Olmsted Medical Center institutional review boards granted approval for this study. Patient records were identified using the Rochester Epidemiology Project (REP), a medical records-linkage system constructed to collect every interaction of patient medical care in Olmstead County, Minnesota. Olmsted County is relatively isolated from surrounding urban areas; as a result, Mayo Clinic or Olmsted Medical Group and affiliated hospitals supply the plurality of medical care provided to county residents. 17 A central electronic patient record connects all medical care information received by the individual including demographics, medical diagnoses, and surgeries.
Cases of conjunctivitis were ascertained using the International Classification of Diseases, Ninth Revision ( ICD-9 ), diagnostic codes for conjunctivitis and red eye. Only patients living in Olmsted County at the time of diagnosis, diagnosed within the study period from 2005 through 2014, and ≤12 months of age at the time of diagnosis were included. Each patient chart was individually reviewed for demographics, diagnoses, and relevant clinical characteristics.
Diagnoses were confirmed based on the information contained within the medical record of each patient. The medical records of children diagnosed with conjunctivitis within 30 days of birth underwent a more detailed review including analysis of ocular surface cultures and therapeutic interventions. Among a total of 2674 individually reviewed records, 394 (14.7%) were excluded for an incorrect diagnosis, 94 (3.5%) for denying research authorization, and 11 (0.4%) for not residing within Olmsted Country. The data were organized using Research Electronic Data Capture (REDCap), a digital software designed to collect research data.
Incidence rates were estimated using the age- and sex-specific population figures from the 2005 through 2014 Olmsted County, Minnesota, census data. Population figures for each year between the census years was calculated using a linear interpolation of the data. The 95% CIs for overall incidence were calculated assuming Poisson error distribution Statistical analysis was performed using SAS, version 9.2 (SAS Institute).
RESULTS
A total of 2175 infants were diagnosed with conjunctivitis during the 10-year period, yielding an incidence of 10,422 per 100,000 children or 1 in 10 infants in the first year of life. The historical and clinical characteristics of the 2175 children are shown in Table 1 . The mean age at diagnosis was 4.9 months (range, 1 day–12 months) and 1001 (46.0%) were female. The diagnosis of conjunctivitis was made by a primary care provider in 1786 (82.1%) and occurred in both eyes in 1180 (54.3%). The incidence of conjunctivitis within 30 days of life in this cohort was 2759 per 100,000 or 1 in 36 cases (2.7%), with the mean age of diagnosis at 19 days. Less than half (42.2%) were females, and bilateral involvement occurred in 222 (38.5%). Concurrent neonatal ocular disorders included dacryostenosis in 160 (27.8%).
| Characteristic | Diagnosed ≤30 d(n = 576) | Diagnosed≤12 mo(n=2175) |
|---|---|---|
| Female | 243 (42) | 1001 (46) |
| Premature birth a (<37 wk of gestational age) | 47 (8) | 52 (2) |
| Age at diagnosis, mean (range) | 19.5 (0-3 d) | 4.9 (0-12 mo) |
| Diagnosis made by | ||
| Primary care b | 479 (83) | 1786 (82) |
| Emergency physician | 22 (5) | 160 (7) |
| Ophthalmologist | 10 (2) | 30 (1) |
| Other c | 65 (11) | 199 (9) |
| Laterality | ||
| Right eye | 168 (29) | 506 (23) |
| Left eye | 186 (32) | 489 (22) |
| Bilateral | 222 (39) | 1180 (54) |
| Other ocular disorder | ||
| Nasolacrimal duct obstruction | 160 (27.8) | |
| Preseptal cellulitis | 1 (0.2) | |
| Subconjunctival hemorrhage | 2 (0.3) |
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