Ophthalmia neonatorum
Encyclopedia
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. If left untreated it can cause blindness.
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.
Ophthalmia neonatorum due to gonococci (Neisseria gonorrhoeae
) typically manifests in the first five 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 three of life, but may occur up to two weeks after delivery. The discharge is usually more watery in nature (mucopurulent) and less inflamed. 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.
Other agents causing ophthalmia neonatorum include Herpes simplex virus
(HSV 2), Staphylococcus aureus
, Streptococcus haemolyticus, Streptococcus pneumoniae
.
1. Use of 1% tetracycline ointment or 0.5% erythromycin ointment or 1% silver nitrate solution (Crede's method) into the eyes of babies immediately after birth
2. Single injection of ceftriaxone 50 mg/kg IM or IV should be given to infants born to mothers with untreated gonococcal infection.
B. Curative treatment as a rule, conjunctival cytology samples and culture sensitivity swabs should be taken before starting treatment
1. Saline levarage hourly till the discharge is eliminated
2. Bacitracin eye ointment four times per day (Because of resistant strains topical penicillin therapy is not reliable. However in cases with proved 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 till infection is controlled)
3. If the cornea is involved then atropine sulphate ointment should be applied.
Systemic therapy: Neonates with gonococcal ophthalmia neonatorum should be treated for seven days with one of the following regimens
Conjunctivitis
Conjunctivitis refers to inflammation of the conjunctiva...
contracted by newborns during delivery
Childbirth
Childbirth is the culmination of a human pregnancy or gestation period with the birth of one or more newborn infants from a woman's uterus...
. The baby's eyes are contaminated during passage through the birth canal from a mother infected with either Neisseria gonorrhoeae
Neisseria gonorrhoeae
Neisseria gonorrhoeae, also known as gonococci , or gonococcus , is a species of Gram-negative coffee bean-shaped diplococci bacteria responsible for the sexually transmitted infection gonorrhea.N...
or Chlamydia trachomatis
Chlamydia trachomatis
Chlamydia trachomatis, an obligate intracellular human pathogen, is one of three bacterial species in the genus Chlamydia. C. trachomatis is a Gram-negative bacteria, therefore its cell wall components retain the counter-stain safranin and appear pink under a light microscope.The inclusion bodies...
. Eyedrops containing erythromycin
Erythromycin
Erythromycin is a macrolide antibiotic that has an antimicrobial spectrum similar to or slightly wider than that of penicillin, and is often used for people who have an allergy to penicillins. For respiratory tract infections, it has better coverage of atypical organisms, including mycoplasma and...
are typically used to prevent the condition. 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.Non infectious
Chemical irritants such as silver nitrateSilver nitrate
Silver nitrate is an inorganic compound with chemical formula . This compound is a versatile precursor to many other silver compounds, such as those used in photography. It is far less sensitive to light than the halides...
can cause chemical conjunctivitis, usually lasting 2–4 days. Thus, silver nitrate is no longer in common use. In most countries neomycin
Neomycin
Neomycin is an aminoglycoside antibiotic that is found in many topical medications such as creams, ointments, and eyedrops. The discovery of Neomycin dates back to 1949. It was discovered in the lab of Selman Waksman, who was later awarded the Nobel Prize in Physiology and medicine in 1951...
and chloramphenicol
Chloramphenicol
Chloramphenicol is a bacteriostatic antimicrobial that became available in 1949. It is considered a prototypical broad-spectrum antibiotic, alongside the tetracyclines, and as it is both cheap and easy to manufacture it is frequently found as a drug of choice in the third world.Chloramphenicol is...
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
Neisseria gonorrhoeae
Neisseria gonorrhoeae, also known as gonococci , or gonococcus , is a species of Gram-negative coffee bean-shaped diplococci bacteria responsible for the sexually transmitted infection gonorrhea.N...
) typically manifests in the first five days of life and is associated with marked bilateral purulent discharge and local inflammation. In contrast, conjunctivitis secondary to infection with chlamydia (Chlamydia trachomatis
Chlamydia trachomatis
Chlamydia trachomatis, an obligate intracellular human pathogen, is one of three bacterial species in the genus Chlamydia. C. trachomatis is a Gram-negative bacteria, therefore its cell wall components retain the counter-stain safranin and appear pink under a light microscope.The inclusion bodies...
) produces conjunctivitis after day three of life, but may occur up to two weeks after delivery. The discharge is usually more watery in nature (mucopurulent) and less inflamed. 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.
Other agents causing ophthalmia neonatorum include Herpes simplex virus
Herpes simplex virus
Herpes simplex virus 1 and 2 , also known as Human herpes virus 1 and 2 , are two members of the herpes virus family, Herpesviridae, that infect humans. Both HSV-1 and HSV-2 are ubiquitous and contagious...
(HSV 2), Staphylococcus aureus
Staphylococcus aureus
Staphylococcus aureus is a facultative anaerobic Gram-positive coccal bacterium. It is frequently found as part of the normal skin flora on the skin and nasal passages. It is estimated that 20% of the human population are long-term carriers of S. aureus. S. aureus is the most common species of...
, Streptococcus haemolyticus, Streptococcus pneumoniae
Streptococcus pneumoniae
Streptococcus pneumoniae, or pneumococcus, is Gram-positive, alpha-hemolytic, aerotolerant anaerobic member of the genus Streptococcus. A significant human pathogenic bacterium, S...
.
Signs and symptoms
- Pain and tenderness in eyeball
- Conjunctival discharge:purulent, mucoid or mucopurulent depending on the cause.
- Conjunctiva shows hyperaemia and chemosis. Eyelids are usually swollen.
- Corneal involvement (rare) may occur in herpes simplex ophthalmia neonatorum.
Complications
Untreated cases may develop corneal ulceration, which may perforate resulting in corneal opacification and Staphyloma formation.Treatment
A. Prophylaxis needs antenatal, natal and post-natal care.- Antenatal measures include thorough care of mother and treatment of genital infections when suspected.
- Natal measures are of utmost importance as mostly infection occurs during childbirth. Deliveries should be conducted under hygienic conditions taking all asceptic measures. The newborn baby's closed lids should be thoroughly cleansed and dried.
- Postnatal measures include:
1. Use of 1% tetracycline ointment or 0.5% erythromycin ointment or 1% silver nitrate solution (Crede's method) into the eyes of babies immediately after birth
2. Single injection of ceftriaxone 50 mg/kg IM or IV should be given to infants born to mothers with untreated gonococcal infection.
B. 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
1. Saline levarage hourly till the discharge is eliminated
2. Bacitracin eye ointment four times per day (Because of resistant strains topical penicillin therapy is not reliable. However in cases with proved 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 till infection is controlled)
3. If the cornea is involved then atropine sulphate ointment should be applied.
Systemic therapy: Neonates with gonococcal ophthalmia neonatorum should be treated for seven days with one of the following regimens
| Ceftriaxone Ceftriaxone Ceftriaxone is a third-generation cephalosporin antibiotic. Like other third-generation cephalosporins, it has broad spectrum activity against Gram-positive and Gram-negative bacteria. In most cases, it is considered to be equivalent to cefotaxime in terms of safety and efficacy... 75–100 mg/kg/day IV or IM, QID |
| Cefotaxime Cefotaxime Cefotaxime is a third-generation cephalosporin antibiotic. Like other third-generation cephalosporins, it has broad spectrum activity against Gram positive and Gram negative bacteria... 100–150 mg/kg/day IV or IM, 12 hourly |
| Ciprofloxacin Ciprofloxacin Ciprofloxacin is a synthetic chemotherapeutic antibiotic of the fluoroquinolone drug class.It is a second-generation fluoroquinolone antibacterial. It kills bacteria by interfering with the enzymes that cause DNA to rewind after being copied, which stops synthesis of DNA and of... 10–20 mg/kg/day or Norfloxacin 10 mg/kg/day |
| Crystalline benzyl penicillin Penicillin Penicillin is a group of antibiotics derived from Penicillium fungi. They include penicillin G, procaine penicillin, benzathine penicillin, and penicillin V.... G 50,000 units (for full-term normal weight babies) or 20,000 units (for premature or low weight babies) IM twice daily for three days (if the organism is penicillin susceptible) |
- Other bacterial ophthalmia neonatorum should be treated by broad spectrum antibiotics drops and ointment for two weeks.
- Neonatal inclusion conjunctivitis caused by Chlamydia trachomatis responds well to topical tetracycline 1% or erythromycin 0.5% eye ointment QID for three weeks. However systemic erythromycin should also be given since the presence of chlamydia agents in conjunctiva implies colonization of upper respiratory tract as well. Both parents should also be treated with systemic erythromycin.
- Herpes simplex conjunctivitis is usually a self-limiting disease. Topical antiviral drugs control the infection more effectively and may prevent recurrence.