Neonatal conjunctivitis

Neonatal conjunctivitis
Classification and external resources
A newborn with gonococcal ophthalmia neonatorum.
ICD-10	A54.3, P39.1
ICD-9	098.40, 771.6
DiseasesDB	9237
eMedicine	oph/325
MeSH	D009878

Neonatal conjunctivitis, also known as ophthalmia neonatorum, is a form of bacterial conjunctivitis contracted by newborns during delivery. The baby's eyes are contaminated during passage through the birth canal from a mother infected with either Neisseria gonorrhoeae or Chlamydia trachomatis. Eyedrops containing erythromycin are typically used to prevent the condition.^[1] If left untreated it can cause blindness.

Definition

Neonatal conjunctivitis by definition presents during the first month of life. It may be infectious or non infectious.^[2]

Cause

Non infectious

Chemical irritants such as silver nitrate can cause chemical conjunctivitis, usually lasting 2–4 days. Thus, silver nitrate is no longer in common use. In most countries neomycin and chloramphenicol eye drops are used instead.

Infectious

Many different bacteria and viruses can cause conjunctivitis in the neonate. The two most feared causes are N. gonorrheae and Chlamydia acquired from the birth canal during delivery.

Ophthalmia neonatorum due to gonococci (Neisseria gonorrhoeae) typically manifests in the first five days of life and is associated with marked bilateral purulent discharge and local inflammation. In contrast, conjunctivitis secondary to infection with chlamydia (Chlamydia trachomatis) produces conjunctivitis after day three of life, but may occur up to two weeks after delivery. The discharge is usually more watery in nature (mucopurulent) and less inflamed. Babies infected with chlamydia may develop pneumonitis (chest infection) at a later stage (range 2 weeks – 19 weeks after delivery). Infants with chlamydia pneumonitis should be treated with oral erythromycin for 10–14 days.^[3]

Other agents causing ophthalmia neonatorum include Herpes simplex virus (HSV 2), Staphylococcus aureus, Streptococcus haemolyticus, Streptococcus pneumoniae.

Signs and symptoms

1. Pain and tenderness in eyeball
2. Conjunctival discharge:purulent, mucoid or mucopurulent depending on the cause.
3. Conjunctiva shows hyperaemia and chemosis. Eyelids are usually swollen.
4. Corneal involvement (rare) may occur in herpes simplex ophthalmia neonatorum.

Complications

Untreated cases may develop corneal ulceration, which may perforate resulting in corneal opacification and Staphyloma formation.

Treatment

A. Prophylaxis needs antenatal, natal and post-natal care.

1. Antenatal measures include thorough care of mother and treatment of genital infections when suspected.
2. Natal measures are of utmost importance as mostly infection occurs during childbirth. Deliveries should be conducted under hygienic conditions taking all asceptic measures. The newborn baby's closed lids should be thoroughly cleansed and dried.
3. Postnatal measures include:

1. Use of 1% tetracycline ointment or 0.5% erythromycin ointment or 1% silver nitrate solution (Crede's method) into the eyes of babies immediately after birth 2. Single injection of ceftriaxone 50 mg/kg IM or IV should be given to infants born to mothers with untreated gonococcal infection. B. Curative treatment as a rule, conjunctival cytology samples and culture sensitivity swabs should be taken before starting treatment

• Chemical ophthalmia neonatorum is a self-limiting condition and does not require any treatment.
• Gonococcal ophthalmia neonatorum needs prompt treatment to prevent complications. Topical therapy should include

1. Saline levarage hourly till the discharge is eliminated 2. Bacitracin eye ointment four times per day (Because of resistant strains topical penicillin therapy is not reliable. However in cases with proved penicillin susceptibility, penicillin drops 5000 to 10000 units per ml should be instilled every minute for half an hour, every five minutes for next half an hour and then half-hourly till infection is controlled) 3. If the cornea is involved then atropine sulphate ointment should be applied. Systemic therapy: Neonates with gonococcal ophthalmia neonatorum should be treated for seven days with one of the following regimens

Ceftriaxone 75–100 mg/kg/day IV or IM, QID

Cefotaxime 100–150 mg/kg/day IV or IM, 12 hourly

Ciprofloxacin 10–20 mg/kg/day or Norfloxacin 10 mg/kg/day

Crystalline benzyl penicillin G 50,000 units (for full-term normal weight babies) or 20,000 units (for premature or low weight babies) IM twice daily for three days (if the organism is penicillin susceptible)

• Other bacterial ophthalmia neonatorum should be treated by broad spectrum antibiotics drops and ointment for two weeks.
• Neonatal inclusion conjunctivitis caused by Chlamydia trachomatis responds well to topical tetracycline 1% or erythromycin 0.5% eye ointment QID for three weeks. However systemic erythromycin should also be given since the presence of chlamydia agents in conjunctiva implies colonization of upper respiratory tract as well. Both parents should also be treated with systemic erythromycin.
• Herpes simplex conjunctivitis is usually a self-limiting disease. Topical antiviral drugs control the infection more effectively and may prevent recurrence.

References

1. ^ "MedlinePlus - Neonatal Conjunctivitis". http://www.nlm.nih.gov/medlineplus/ency/article/001606.htm. Retrieved 2008-08-28. 
2. ^ "Conjunctivitis, Neonatal: Overview - eMedicine". http://emedicine.medscape.com/article/1192190-overview. 
3. ^ "Red Book - Report of the Committee on Infectious Diseases, 29th Edition. The American Academy of Pediatrics.". http://aapredbook.aappublications.org/. Retrieved 2007-07-12. 

See also

• List of systemic diseases with ocular manifestations