Neonatal conjunctivitis

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Neonatal conjunctivitis
Other namesOphthalmia neonatorum
Gonococcal ophthalmia neonatorum.jpg
A newborn with gonococcal ophthalmia neonatorum
Specialty Pediatrics   OOjs UI icon edit-ltr-progressive.svg

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]

Contents

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.

Signs and symptoms

Neonatal conjunctivitis by definition presents during the first month of life. Signs and symptoms include:[ citation needed ]

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) [2]

Complications

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]

Cause

Non-infectious

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 ]

Infectious

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 ]

Prevention

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.

Treatment

Systemic therapy: Newborns with gonococcal ophthalmia neonatorum should be treated for 7 days with ceftriaxone, cefotaxime, ciprofloxacin, or crystalline benzyl penicillin.

Epidemiology

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]

See also

References

  1. "Conjunctivitis, Neonatal: Overview". eMedicine. 2019-05-30.
  2. 1 2 Tan, Aik-Kah (2019-01-09). "Ophthalmia Neonatorum". New England Journal of Medicine. 380 (2): e2. doi:10.1056/NEJMicm1808613. PMID   30625059. S2CID   58654865.
  3. 1 2 3 4 Matejcek, A; Goldman, RD (November 2013). "Treatment and prevention of ophthalmia neonatorum". Canadian Family Physician. 59 (11): 1187–90. PMC   3828094 . PMID   24235191.
  4. 1 2 "Conjunctivitis | Pink Eye | Newborns". www.cdc.gov. Retrieved 2016-11-11.
  5. 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 . PMID   30694327.
  6. 1 2 3 Schmidt, Axel (2007), Schroten, Horst; Wirth, Stefan (eds.), "Gonorrheal ophthalmia neonatorum: Historic impact of Credé's eye prophylaxis", Pediatric Infectious Diseases Revisited, Birkhäuser Advances in Infectious Diseases, Basel: Birkhäuser, pp. 95–115, doi:10.1007/978-3-7643-8099-1_4, ISBN   978-3-7643-8099-1 , retrieved 2023-11-04
  7. Mallika, PS; Asok, T; Faisal, HA; Aziz, S; Tan, AK; Intan, G (2008-08-31). "Neonatal Conjunctivitis – a Review". Malaysian Family Physician. 3 (2): 77–81. ISSN   1985-207X. PMC   4170304 . PMID   25606121.
  8. Edwards, Keith H. (2009). Optometry: Science, Techniques and Clinical Management. Elsevier Health Sciences. p. 102. ISBN   978-0750687782. Archived from the original on 2017-03-07.
  9. "Chloramphenicol". The American Society of Health-System Pharmacists. Archived from the original on 2015-06-24. Retrieved Aug 1, 2015.
  10. "Conjunctivitis in Children". www.hopkinsmedicine.org. Johns Hopkins Medicine Health Library. Retrieved 2016-11-11.
  11. "Red Book – Report of the Committee on Infectious Diseases, 29th Edition". The American Academy of Pediatrics. Retrieved 2007-07-12.
  12. Peter.H (2000). "Dr Carl Credé (1819–1892) and the prevention of ophthalmia neonatorum". Arch Dis Child Fetal Neonatal Ed. 83 (2): F158 –F159. doi:10.1136/fn.83.2.F158. PMC   1721147 . PMID   10952715.
  13. Credé C. S. E. (1881). "Die Verhürtung der Augenentzündung der Neugeborenen". Archiv für Gynäkologie. 17 (1): 50–53. doi:10.1007/BF01977793. S2CID   10053605.
  14. 1 2 Schaller, Ulrich C. & Klauss, Volker (2001). "Is Credés prophylaxis for ophthalmia neonatorum still valid?". Bulletin of the World Health Organization. 79 (3): 262–266. PMC   2566367 . PMID   11285676.
  15. "Conjunctivitis". The Lecturio Medical Concept Library. 23 July 2020. Retrieved 10 July 2021.
  16. American Academy of Pediatrics. "Chlamydia trachomatis". In: Red Book: 2015 Report of the Committee on Infectious Diseases, 30th, Kimberlin DW (Ed), Elk Grove Village, IL p. 288.
  17. 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. PMID   3890519.
  18. Hammerschlag Margaret R.; et al. (1982). "Longitudinal studies on chlamydial infections in the first year of life". The Pediatric Infectious Disease Journal. 1 (6): 395–401. doi:10.1097/00006454-198211000-00007. PMID   7163029. S2CID   27570122.
  19. "Neonatal Conjunctivitis Treatment & Management: Treatment of Neonatal Herpetic Conjunctivitis" . Retrieved 2013-08-11.
  20. Dharmasena, A; Hall, N; Goldacre, R; Goldacre, MJ (August 2015). "Time trends in ophthalmia neonatorum and dacryocystitis of the newborn in England, 2000-2011: database study". Sex Transm Infect. 91 (5): 342–5. doi:10.1136/sextrans-2014-051682. PMID   25512672. S2CID   36391207.