Ophthalmia Neonatorum (Neonatal Conjunctivitis)

Introduction

Ophthalmia Neonatorum is infection in both eyes of a newborn baby in the first one month of life, without obstruction of the nasolacrimal ducts. It is an acute emergency and requires immediate treatment and referral because of the significant risk of corneal perforation and intraocular infection that can lead to blindness.

Clinical features

  • Swollen eyelids: It may be impossible to see the baby’s eye because of the swelling
  • Red eyes: The conjunctivae are less inflamed in chlamydial infection
  • Pus: Oozes out when the eyelids are opened
  • Fever: May or may not be present

Aetiology

Bacterial:

  • Especially Neisseria gonorrhoea: starts within 3 days after birth
  • Chlamydia (usually starts 1 week after birth)

Chemicals: prophylactic silver nitrate
Others: viral

Differential diagnosis

  • Lid oedema following prolonged difficult labour

Complications

  • Corneal perforation
  • Endophthalmitis

Investigation

  • Conjunctival swab for microscopy, culture and sensitivity

Management

Non-drug measures

  • Copious irrigation to wash pus from the eyes with sodium chloride 0.9% (sterile isotonic saline)

Drug treatment

Treatment of Baby

Empirical treatment against both (Chlamydia trachomatis and Neisseria gonorrhoeae) should start if there is suspicious of Ophthalmia Neonatorum. This is to prevent complications.
If diagnosis of gonococcal ophthalmia neonatorum is established, initiate treatment immediately.
The first-line treatment of choice is a single dose of ceftriaxone 25 to 50 mg/kg/24 hr, with a maximum of 125 mg.
An alternative regimen is cefotaxime 100 mg/kg in a single dose.
If chlamydial conjunctivitis is confirmed, oral erythromycin 50 mg/kg/24 hr for two weeks is the regimen of choice; topical erythromycin can be used as adjunct therapy as well.
Conjunctivitis secondary to staphylococcal species and pseudomonas requires treatment with systemic antibiotics.
Patients with herpes simplex conjunctivitis should have treatment with systemic antiviral therapy, along with topical ophthalmic drugs. This should include 0.15% ganciclovir or 1% trifluridine for 14 days.

Treatment of Mother

Evidence Rating: [A]
Ceftriazone, IM, 250 mg stat.

And

Erythromycin, oral, 500 mg 6 hourly for 7 days

Treatment of mother’s partner(s) for gonorrhoea and chlamydia

Ceftriazone, IM, 250 mg stat.

Or

Cefixime, oral, 400 mg stat.

Or

Ciprofloxacin, oral, 500 mg stat.

And

Doxycycline, oral, 100 mg 12 hourly for 7 days

Or

Tetracycline, oral, 500 mg 6 hourly for 7 days

Or

Erythromycin, oral, 500 mg 6 hourly for 7 days

Or

Azithromycin, oral, 1 g stat.

Caution

  • Do not use steroids eyedrops
  • Penicillin drops are not effective in the treatment of opthalmia neonatorum

Prevention

  • Apply tetracycline eye ointment or silver nitrate drops in both eyes of neonates immediately after delivery
  • Proper antenatal care for early detection of infection in mothers