Neonatal conjunctivitis
Neonatal conjunctivitis is a form of conjunctivitis (inflammation of the outer eye) which affects newborn babies following birth. It is typically due to neonatal bacterial infection, although it can also be non-infectious (e.g. chemical exposure).[1] Infectious neonatal conjunctivitis is typically contracted during vaginal delivery from exposure to bacteria from the birth canal, most commonly Neisseria gonorrhoeae or Chlamydia trachomatis.[2]
Neonatal conjunctivitis
Ophthalmia neonatorum
Antibiotic ointment is typically applied to the newborn's eyes within 1 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 cause blindness.
Cause[edit]
Non-infectious[edit]
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.[6] In most countries, neomycin and chloramphenicol eye drops are used, instead.[7][8] However, newborns can develop neonatal conjunctivitis due to reactions with chemicals in these common eye drops.[9] A blocked tear duct may also be another noninfectious cause of neonatal conjunctivitis.
Infectious[edit]
The two most common infectious causes of neonatal conjunctivitis are N. gonorrheae and Chlamydia, typically acquired from the birth canal during delivery. However, other different bacteria and viruses can be the cause, including herpes simplex virus (HSV 2), Staphylococcus aureus, Streptococcus pyogenes, and Streptococcus pneumoniae.
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 (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.[10]
Diagnosis is performed after taking swab from the infected conjunctivae.
Prevention[edit]
Antibiotic ointment is typically applied to the newborn's eyes within 1 hour of birth as prevention against gonococcal ophthalmia.[3] This may be erythromycin, tetracycline, or rarely silver nitrate[3] or Argyrol (mild silver protein).
Prophylaxis needs antenatal, natal, and postnatal care.
Systemic therapy: Newborns with gonococcal ophthalmia neonatorum should be treated for 7 days with ceftriaxone, cefotaxime, ciprofloxacin, or crystalline benzyl penicillin.