Neonatal conjunctivitis is a form ofconjunctivitis (inflammation of the outer eye) which affects newborn babies following birth. It is typically due toneonatal bacterial infection, although it can also be non-infectious (e.g., chemical exposure).[1] Infectious neonatal conjunctivitis is typically contracted duringvaginal delivery from exposure to bacteria from the birth canal, most commonlyNeisseria gonorrhoeae orChlamydia trachomatis.[2]
Antibiotic ointment is typically applied to the newborn's eyes within one hour of birth as prevention for gonococcal ophthalmia.[3] 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.[4][5]
If left untreated, neonatal conjunctivitis can causeblindness.
Chemical irritants such assilver nitrate can cause chemical conjunctivitis, usually lasting 2–4 days. Thus, prophylaxis with a 1% silver nitrate solution is no longer in common use.[7] In most countries,neomycin andchloramphenicol eye drops are used, instead.[8][9]However, newborns can develop neonatal conjunctivitis due to reactions with chemicals in these common eye drops.[10] A blocked tear duct may also be another noninfectious cause of neonatal conjunctivitis.[citation needed]
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 withC. trachomatis produces conjunctivitis 3 days to 2 weeks after delivery. The discharge is usually more watery (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.[11]
Diagnosis is performed after taking a swab from the infected conjunctivae.[citation needed]
Prophylaxis needs antenatal, natal, and postnatal care.
Antenatal measures include thorough care of the 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, 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.[4]
Postnatal measures include:
Use of 1%tetracycline ointment, 0.5% erythromycin ointment, or 1-2% silver nitrate solution (Credé's method) into the eyes of babies immediately after birth.[6]
Single injection ofceftriaxone 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 until 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 until the infection is controlled.)
If the cornea is involved, thenatropine sulfate ointment should be applied.
The advice of both the pediatrician and ophthalmologist should be sought for proper management.
Systemic therapy: Newborns with gonococcal ophthalmia neonatorum should be treated for 7 days with ceftriaxone,cefotaxime,ciprofloxacin, or crystalline benzylpenicillin.
Other bacterial ophthalmia neonatorum should be treated with broad-spectrum antibiotic drops and ointment for 2 weeks.
Neonatal inclusion conjunctivitis caused byC. trachomatis should be treated with oral erythromycin.[15] Topical therapy is not effective and also does not treat the infection of the nasopharynx.[16][17][18]
The incidence of neonatal conjunctivitis varies widely depending on the geographical location. The incidence in England was 257 (95% confidence interval: 245 to 269) per 100,000 in 2011.[20]
In late 19th-century Europe, the prevalence of ophthalmia neonatorum among live births in maternity hospitals exceeded 10%, with blindness in 3% of affected infants. Half of the children in blind schools were there because of it,[14] and in Germany, it accounted for 25-40% of cases of blindness[6]
^Curry, Susan J.; Krist, Alex H.; Owens, Douglas K.; Barry, Michael J.; Caughey, Aaron B.; Davidson, Karina W.; Doubeni, Chyke A.; Epling, John W.; Kemper, Alex R.; Kubik, Martha; Landefeld, C. Seth; Mangione, Carol M.; Silverstein, Michael; Simon, Melissa A.; Tseng, Chien-Wen; Wong, John B. (29 January 2019)."Ocular Prophylaxis for Gonococcal Ophthalmia Neonatorum".JAMA.321 (4):394–98.doi:10.1001/jama.2018.21367.PMID30694327.
^Credé C. S. E. (1881). "Die Verhürtung der Augenentzündung der Neugeborenen".Archiv für Gynäkologie.17 (1):50–53.doi:10.1007/BF01977793.S2CID10053605.
^"Conjunctivitis".The Lecturio Medical Concept Library. 23 July 2020. Retrieved10 July 2021.
^American Academy of Pediatrics. "Chlamydia trachomatis". In: Red Book: 2015Report of the Committee on Infectious Diseases, 30th, Kimberlin DW (Ed), Elk Grove Village, IL p. 288.
^Heggie Alfred D.; et al. (1985). "Topical sulfacetamide vs oral erythromycin for neonatal chlamydial conjunctivitis".American Journal of Diseases of Children.139 (6):564–66.doi:10.1001/archpedi.1985.02140080034027.PMID3890519.
