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	[1]

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 5 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 3 of life, but may occur up to 2 weeks after delivery. The discharge is usually more watery in nature (mucopurulent) and less inflammed. 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]

Gonococcal infection in eyes is uncommon nowadays but very serious. Quinolone topical antibiotic eye drops are effective. 10% sulphacetamide may be a good alternative.

Treatment

Fucithalmic acid and chloramphenicol topically are commonly used.^[4] If the newborn is systemically ill, then intravenous treatment might be considered. Treatments for N. gonorrhea conjunctivitis include an intravenous dose of benzylpenicillin or cefotaxime. IV erythromycin and topical tetracycline is used for treatment of chlamydial conjunctivitis.^{[citation needed]} Dual infections of both gonorrhoea and chlamydia is common and should be taken into consideration.^{[citation needed]}

References

1. ^ "MedlinePlus - Neonatal Conjunctivitis". http://www.nlm.nih.gov/medlineplus/ency/article/001606.htm. Retrieved on 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 on 2007-07-12. 
4. ^ "BestBets: In neonates with sticky eyes, is Fucithalmic (fucidic acid) eye ointment as good as Chloramphenicol 1% ointment?". http://www.bestbets.org/bets/bet.php?id=1513. 

See also

• List of systemic diseases with ocular manifestations

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