Neonatal conjunctivitis - Wikipedia, the free encyclopedia

26/04/15 04:02

Neonatal conjunctivitis
From Wikipedia, the free encyclopedia

Neonatal conjunctivitis, also

known as ophthalmia neonatorum,
is a form of 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. Ophthalmic
ointment containing 0.5%
erythromycin is typically applied to
the newborn's eyes within 1 hour of
birth as prophylaxis against

Neonatal conjunctivitis

A newborn with gonococcal ophthalmia neonatorum.

Classification and external resources
ICD-10

A54.3
(http://apps.who.int/classifications/icd10/browse/2015/en#/A54.3),
P39.1
(http://apps.who.int/classifications/icd10/browse/2015/en#/P39.1)

ICD-9

098.40 (http://www.icd9data.com/getICD9Code.ashx?
icd9=098.40), 771.6
(http://www.icd9data.com/getICD9Code.ashx?icd9=771.6)

gonococcal ophthalmia.[1] If left

untreated it can cause blindness.

Contents
1 Definition

DiseasesDB 9237 (http://www.diseasesdatabase.com/ddb9237.htm)

2 Cause
2.1 Non infectious

MedlinePlus 001606
(http://www.nlm.nih.gov/medlineplus/ency/article/001606.htm)

2.2 Infectious

eMedicine

oph/325 (http://www.emedicine.com/oph/topic325.htm)

MeSH

D009878 (https://www.nlm.nih.gov/cgi/mesh/2015/MB_cgi?
field=uid&term=D009878)

3 Signs and symptoms

4 Complications
5 Treatment
6 References
7 See also

Definition
Neonatal conjunctivitis by definition presents during the first month of life. It may be infectious or non
infectious.[2] In infectious conjunctivitis, the organism is transmitted from the genital tract of an infected mother
during birth or by infected hands.

Cause
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Non infectious
Chemical irritants such as silver nitrate can cause chemical conjunctivitis, usually lasting 24 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 post
birth 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 post birth, 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 1014 days.[3]
Other agents causing ophthalmia neonatorum include Herpes simplex virus (HSV 2), Staphylococcus aureus,
Streptococcus haemolyticus, Streptococcus pneumoniae.
Time of onset depending of the cause
Chemical causes: Right after delivery
Neisseria gonorrhoeae: Delivery of the baby until 5 days post-birth (Early onset)
Chlamydia trachomatis: 5 days post-birth to 2 weeks (Late onset - C.trachomatis has longer incubation period)

Signs and symptoms

Pain and tenderness in the eyeball.
Conjunctival discharge: purulent, mucoid or mucopurulent depending on the cause.
Conjunctiva shows hyperaemia and chemosis. Eyelids are usually swollen.
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
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Prophylaxis needs antenatal, natal, and post-natal care.

Antenatal measures include thorough care of mother and treatment of genital infections when suspected.
Natal measures are of utmost importance as mostly infection occurs during childbirth. Deliveries should
be conducted under hygienic conditions taking all aseptic measures. The newborn baby's closed lids
should be thoroughly cleansed and dried.
Postnatal measures include:
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
Single injection of ceftriaxone 50 mg/kg IM or IV should be given to infants born to mothers with
untreated gonococcal infection.
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
Saline lavage hourly till the discharge is eliminated
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)
If the cornea is involved then atropine sulphate ointment should be applied.
The advice of both the pediatrician and ophthalmologist should be sought for proper management.
Systemic therapy: Neonates with gonococcal ophthalmia neonatorum should be treated for seven days with
one of the following regimens
Ceftriaxone 75100 mg/kg/day IV or IM, QID
Cefotaxime 100150 mg/kg/day IV or IM, 12 hourly
Ciprofloxacin 1020 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)
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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 should be treated with intravenous acyclovir for a minimum of 14 days to
prevent systemic infection.[4]

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.
4. "Neonatal Conjunctivitis Treatment & Management: Treatment of Neonatal Herpetic Conjunctivitis."
(http://emedicine.medscape.com/article/1192190-treatment#aw2aab6b6b3). Retrieved 2013-08-11.

See also
List of systemic diseases with ocular manifestations
Retrieved from "http://en.wikipedia.org/w/index.php?title=Neonatal_conjunctivitis&oldid=648433693"
Categories: Diseases of the eye and adnexa Neonatology Disorders of conjunctiva
Herpes simplex virus-associated diseases
This page was last modified on 23 February 2015, at 05:33.
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