Neonatal conjunctivitis
Background
- Vesicles + conjunctivitis = full sepsis eval + acyclovir
Clinical Features
Chlamydia
- Can range from mild to severe hyperemia w/ thick mucopurulent discharge
Gonococcal
- May present as typical conjunctivitis or w/ severe lid edema, cornea ulceration
Differential Diagnosis
- Chemical
- Due to ocular prophylaxis
- Occurs on 1st day of life
- Gonococcal
- Peaks at 3-5 days after birth
- Has potential to cause loss of vision
- Chlamydia
- Peaks from 1wk to 1 month after birth
- Leading cause of preventable blindness in the world
- Herpetic
- Peaks at 6-14 days of life
- May lead to keratitis and disseminated infection
Diagnosis
- Gram stain/culture to r/o N. gonorrhea vs C. trachomatis
- C. trachomatis will have negative gram stain because it is an intracellular parasite.
Treatment
Gonococcal
- Cefotaxime 100mg/kg IV or IM OR ceftriaxone 25-50mg/kg IV or IM x1 (not to exceed 125mg)
- Cefotaxime is preferred because it does not displace bilirubin
- Disseminated disease should be suspected until CSF is negative
- Topical treatment is unnecessary
Chlamydia
- Azithromycin 20mg/kg PO once daily x 3 days OR
- Erythromycin 50mg/kg PO QD in 4 divided doses x 14 days
- Disease manifests 5 days post-birth to 2 weeks (late onset)
- Topical treatment is unnecessary
Herpetic
- Acyclovir 20mg/kg IV q8hr x 14-21d
- Topical antiviral
- Full sepsis evaluation
Chemical
- Watchful waiting
Disposition
- Gonococcal
- Admit
- Herpetic
- Admit
See Also
Source
Tintinalli