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Final
Final
03/08/2022
PREMAALOSHINEE THANABAL
Baby Y , 10 days’ old boy , born via SVD ( 38 weeks and 2 days )
• presented with right eye lid swelling for 2/7 ( at day 8 of life)
• associated with yellowish purulent discharge for 1/7
• no eye redness/ bleeding
• no fever
• no vomiting
• feeding as usual
• no incosolable cry
• no history of ill contact
• no family members with similar symptoms
• History of presenting illness
• The baby was brought to klinik kesihatan on
22/7/22 , for jaundice check-up.
• He was noted to have two episodes of hypotermia
there, hence referred to:
• Paeds team to rule out sepsis
• Ophthal team for ophthalmia neonatorum
• ANC:
• Premature rupture of membrane <18 H
UFEME(13/7/2022) : Not suggestive of urinary tract infection
High vaginal swab (13/7/2022): No growth
• Resolved anemia in pregnancy
• Mother details:
1. booked pregnacy
2. denies multiple sexual partner
3. throughout pregnacy denies any foul smelling discharge ,
4. no STD/ hep and hep c : negative / hiv : negative
OCULAR Examination 22/07/2022
RE LE
unable to assess visual acuity VA able to follow light
No RAPD
swollen , erythematous , yellowish Lid Not swollen, minimal yellowish
purulent discharge ++,no vesicle lesion, discharge, no vescle lesion,
Everted: minimal pseudomembrane Everted: no pseudomembrane
Round/reactive Pupil Round/reactive
White, no chemosis Conjunctiva White, no chemosis
Clear, no stain uptake Cornea Clear
formed, no obvious hypopyon AC Formed, no obvious hypopyon
Clear Lens Clear
OD Pink CDR 0.2, Macula normal, Retina Fundus OD Pink CDR 0.2, Macula normal, Retina
flat flat
Investigation Results
Ix Result
FBC WCC: 21.1 ( predominant
neutrophil )
Hb 13.1, Plt 376
LFT normal
RP Normal
Blood No growth
c&s(22/7/22)
Eye swab c&s No growth
(22/7/22)
DIAGNOSIS
1.Bilateral eye ophthalmia neonatorum
2. TRO sepsis ( baby of mother PPROM )
MANAGEMENT
• G. Vigamox 2 Hourly Right Eye
• G. Vigamox 4 Hourly Left Eye
• Bilateral Eye Lid hygiene TDS
• Eye Swab C& S
• Blood c&s
• Iv Cefotaxime 145mg bd( 50mg /kg / dose )
OCULAR Examination 23/07/2022
RE LE
unable to assess visual acuity VA able to follow light
No RAPD
swollen , erythematous , yellowish Lid Not swollen, minimal yellowish
purulent discharge reducing,no vesicular discharge, no vesicular eye lid lesion
eye lid lesion, Everted: minimal Everted: no pseudomembrane
pseudomembrane
Round/reactive Pupil Round/reactive
White, no chemosis Conjunctiva White, no chemosis
parental
ill contact of
symptoms of
conjuctivitis
sti
uncanalized
systemic illness
nasolacrimal
of child
duct
Predisposing Factor
• organism in vagina shed during delivery
• premature rupture of membrane
• long delivery
• low level igA
• trauma to epithelial barrier
• prophylaxis for gonorrohea ( antibiotic , silver nitrate )
----->( Silver nitrate effectively prevents gonococcal ophthalmia
neonatorum) high risk of developing chemical conjunctivitis
euro