|Other names||Ophthalmia neonatorum|
|A newborn with gonococcal ophthalmia neonatorum|
Neonatal conjunctivitis, is a form of conjunctivitis and a type of neonatal infection contracted by newborns during delivery. The baby's eyes are contaminated during passage through the birth canal from either a chemical cause, or a bacterial infection such as Neisseria gonorrhoeae or Chlamydia trachomatis.
Antibiotic ointment is typically applied to the newborn's eyes within 1 hour of birth as prevention gonococcal ophthalmia. This practice is recommended for all newborns and most hospitals in the United States are required by state law to apply eye drops or ointment soon after birth to prevent the disease.
If left untreated, it can cause blindness.
Signs and symptoms
Neonatal conjunctivitis by definition presents during the first month of life. It may be infectious or noninfectious. In infectious conjunctivitis, the organism is transmitted from the genital tract of an infected mother during birth or by infected hands.
- 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.
Time of onset
Chemical causes: Right after delivery
Neisseria gonorrhoeae: Delivery of the baby until 5 days after birth (early onset)
Chlamydia trachomatis: 5 days after birth to 2 weeks (late onset – C. trachomatis has a longer incubation period)
Untreated cases may develop corneal ulceration, which may perforate, resulting in corneal opacification and staphyloma formation.
Chemical irritants such as silver nitrate can cause chemical conjunctivitis, usually lasting 2–4 days. Thus, prophylaxis with a 1% silver nitrate solution is no longer in common use. In most countries, neomycin and chloramphenicol eye drops are used, instead. However, newborns can suffer from neonatal conjunctivitis due to reactions with chemicals in these common eye drops. Additionally, a blocked tear duct may be another noninfectious cause of neonatal conjunctivitis.
Many different bacteria and viruses can cause conjunctivitis in the neonate. The two most common causes are N. gonorrheae and Chlamydia acquired from the birth canal during delivery.
Ophthalmia neonatorum due to gonococci (N. gonorrhoeae) typically manifests in the first 5 days after birth and is associated with marked bilateral purulent discharge and local inflammation. In contrast, conjunctivitis secondary to infection with C. trachomatis produces conjunctivitis 3 days to 2 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 2–19 weeks after delivery). Infants with chlamydia pneumonitis should be treated with oral erythromycin for 10–14 days.
Other agents causing ophthalmia neonatorum include herpes simplex virus (HSV 2), Staphylococcus aureus, Streptococcus haemolyticus, and Streptococcus pneumoniae. Diagnosis is performed after taking swab from the infected conjuctva.
Antibiotic ointment is typically applied to the newborn's eyes within 1 hour of birth as prevention against gonococcal ophthalmia. This may be erythromycin, tetracycline, or rarely silver nitrate.
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Prophylaxis needs antenatal, natal, and postnatal care.
- Antenatal measures include thorough care of mother and treatment of genital infections when suspected.
- Natal measures are of utmost importance, as most 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.
- If the cause is determined to be due to a blocked tear duct, a gentle palpation between the eye and the nasal cavity may be used to clear the tear duct. If the tear duct is not cleared by the time the newborn is 1 year old, surgery may be required.
- Postnatal measures include:
- Use of 1% tetracycline ointment, 0.5% erythromycin ointment, or 1% silver nitrate solution (Crede's method) into the eyes of babies immediately after birth
- Single injection of ceftriaxone 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, but in cases with proven 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 the 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.
- Other bacterial ophthalmia neonatorum should be treated by broad-spectrum antibiotics drops and ointment for 2 weeks.
- Neonatal inclusion conjunctivitis caused by C. trachomatis should be treated with oral erythromycin. Topical therapy is not effective and also does not treat the infection of the nasopharynx.
- Herpes simplex conjunctivitis should be treated with intravenous acyclovir for a minimum of 14 days to prevent systemic infection.
The disease incidence varies widely depending on the geographical location. In addition to the incidence of this sight-threatening infection, Dharmasena et al also investigated the time trends of the disease. According to them, the incidence of neonatal conjunctivitis (ophthalmia neonatorum) in England was 257 (95% confidence interval: 245 to 269) per 100,000 in 2011.
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