Neonatal conjunctivitis | |
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Other names | Ophthalmia neonatorum |
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A newborn with gonococcal ophthalmia neonatorum | |
Specialty | Pediatrics ![]() |
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]
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.
Neonatal conjunctivitis by definition presents during the first month of life. Signs and symptoms include:[ citation needed ]
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) [2]
Untreated cases may develop corneal ulceration, which may perforate, resulting in corneal opacification and staphyloma formation.[ citation needed ]
Historically in Europe, it led to blindness in 3% of cases and accounted for 25–40% of cases of blindness in Germany. [6]
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. [7] In most countries, neomycin and chloramphenicol 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 ]
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 .[ 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 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. [11]
Diagnosis is performed after taking swab from the infected conjunctivae.[ citation needed ]
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). The use of 1-2% silver nitrate solution was introduced in 1881 by Credé as Credé's prophylaxis. [3] [12] [13] [14]
Prophylaxis needs antenatal, natal, and postnatal care.
This section needs additional citations for verification .(January 2012) |
Systemic therapy: Newborns with gonococcal ophthalmia neonatorum should be treated for 7 days with ceftriaxone, cefotaxime, ciprofloxacin, or crystalline benzyl penicillin.
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 opthalmia neonatorum among live births in maternity hospitals exceeded 10%, with blindness in 3% of affected infants. Half of children in blind schools were there because of it, [14] and in Germany it accounted for 25-40% of cases of blindness [6]