Birth and neonatal risk factors associated with neonatal conjunctivitis: a retrospective case-control study

Neonatal conjunctivitis (NC) is a common ocular condition during the neonatal period and may lead to serious complications if not properly managed. Although maternal conditions contribute to its development, birth-related and neonatal factors also play an important role.

To evaluate birth-related and neonatal factors, along with maternal characteristics, associated with the development of NC.

This retrospective case-control study was conducted at a tertiary referral center and included neonates born between 34 and 42 weeks of gestation between January 2022 and December 2024. A total of 203 neonates diagnosed with conjunctivitis within the first 28 days of life were compared with 355 randomly selected controls without conjunctivitis from the same source population and study period. Maternal, obstetric, neonatal, and laboratory characteristics were extracted from electronic medical records. Univariable and multivariable logistic regression analyses were performed to identify independent predictors of NC.

A total of 558 neonates were included, comprising 203 cases of NC and 355 controls. Neonates with conjunctivitis were more frequently male and had lower gestational age, higher rates of prematurity, and lower Apgar scores than controls. Maternal age, maternal diabetes, and maternal CRP levels were significantly higher among cases. After adjustment for potential confounders, maternal age (OR 1.08, 95% CI 1.03-1.13), maternal diabetes (OR 2.64, 95% CI 1.17-5.94), male sex (OR 1.84, 95% CI 1.24-2.75), and maternal CRP level (OR 1.11, 95% CI 1.07-1.16) were independently associated with neonatal conjunctivitis (all p < 0.05).

In this case-control study, advanced maternal age, maternal diabetes, elevated maternal CRP levels, and male sex were independently associated with NC. Recognition of these maternal and neonatal factors may facilitate earlier identification of at-risk infants and improve postnatal monitoring strategies.