Updated: 12/28/2021

Neonatal Conjunctivitis

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  • Snapshot
    • A female neonate is born via spontaneous vaginal delivery to a G1P0 mother who did not undergo any prenatal care. Her past medical history is notable for drug use. Her pregnancy did not have any complications. After birth, the mother refuses to let the hospital staff administer erythromycin ointment. Two days later, the neonate is noted to have significant eyelid edema and purulent discharge. A scraping of the fluid on Gram stain is noted to have intracellular diplococci, consistent with a diagnosis of gonococcal conjunctivitis. The neonate is given the appropriate medication for treatment. (Gonococcal conjunctivitis)
  • Introduction
    • Overview
      • neonatal conjunctivitis is also known as ophthalmia neonatorum and is categorized as aseptic vs septic
        • aseptic
          • irritant or chemical conjunctivitis
        • septic
          • chlamydial conjunctivitis
          • gonococcal conjunctivitis secondary to N. gonorrhoeae
          • HSV conjunctivitis
    • Epidemiology
      • Incidence
        • septic neonatal conjunctivitis
          • 1-2%
        • Chlamydial conjunctivitis is the most common cause of septic conjunctivitis
    • Pathogenesis
      • mechanism
        • septic conjunctivitis is often obtained as the neonates pass through birth canal
  • Aseptic Conjunctivitis
    • Introduction
      • silver nitrate was used to prevent gonococcal conjunctivitis and a common cause of irritant conjunctivitis
      • this is less common due to use of erythromycin ointment or tetracycline ointment in place of silver nitrate
    • Presentation
      • onset in first few days of life
      • mild tearing and conjunctival injection
      • more severe responses include lid edema, chemosis, and exudate
    • Studies
      • Gram stain
        • neutrophils
    • Treatment
      • typically self-resolves
  • Gonococcal Conjunctivitis
    • Introduction
      • standard prophylaxis given immediately after birth includes topical erythromycin, tetracycline, silver nitrate, or povidone-iodine
    • Presentation
      • occurs 2-7 days after birth or up to 21 days if erythromycin prophylaxis is given
      • severe bilateral purulent conjunctivitis
      • marked lid edema and chemosis
    • Studies
      • Gram stain
        • neutrophils with gram-negative intracellular diplococci with gonococcal conjunctivitis
      • PCR
    • Treatment
      • topical erythromycin
      • IM ceftriaxone
    • Complications
      • peripheral corneal ulceration
      • corneal perforation
  • Chlamydial Conjunctivitis
    • Presentation
      • occurs 5-14 days after birth
      • ranges from mild hyperemia to severe eyelid swelling, pseudomembrane formation, with watery discharge
      • unilateral or bilateral
    • Studies
      • Gram stain
        • neutrophils, lymphocytes, and plasma cells
      • Giemsa stain
        • basophilic intracytoplasmic inclusions
      • polymerase chain reaction (PCR)
    • Treatment
      • oral erythromycin for 14 days
        • systemic treatment needed given risk of pneumonia
    • Complications
      • pneumonia
  • Herpetic Conjunctivitis
    • Presentation
      • occurs in first 2 weeks after birth
      • periocular vesicles
      • lid edema and moderate conjunctival injection
    • Studies
      • Gram stain
        • multinucleated giant cells with herpetic conjunctivitis
      • Giemsa stain
        • eosinophilic intracytoplasmic inclusions with herpetic conjunctivitis
      • PCR
    • Treatment
      • systemic acyclovir for 14-21 days
      • topical 1% trifluridine drops or 3% vidarabine ointment
    • Complications
      • corneal scarring and ulceration

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(M2.PD.14.15) A 3-day-old boy develops bilateral purulent eye discharge. He also exhibits a runny nose, eyelid edema, and redness. The child was born at 39 weeks gestation at home to a mother who did not have prenatal care. His temperature is 97.6°F (36.4°C), blood pressure is 64/44 mmHg, pulse is 120/min, respirations are 27/min, and oxygen saturation is 98% on room air. Physical exam is notable for the finding in Figure A. Which of the following prophylactic measures could have prevented this patient's presentation?

QID: 105381
FIGURES:
1

Acyclovir

5%

(3/61)

2

Azithromycin

5%

(3/61)

3

Ceftriaxone

7%

(4/61)

4

Topical erythromycin

82%

(50/61)

5

Topical silver nitrate

0%

(0/61)

M 7 E

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