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

Prophylaxis

• Erythromycin 0.5% ointment x1 or tetracycline 1% or silver nitrate 1% x1 topical (rarely used because of its potential for causing chemical conjunctivitis), applied at birth.

Chemical

• Watchful waiting

Gonococcal (onset 2-4 days)

• 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
  • Treat mother and partners
  • Irrigate eyes with saline (topical antibiotics are insufficient and unnecessary)

Chlamydia (onset 5-10 days)

• Erythromycin ophthalmic ointment plus one of the following
  • 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)

Herpetic (onset 6-14 days)

• Acyclovir 20mg/kg IV q8hr x 14-21d
• Topical antiviral
• Do not give steroids
• Full neonatal sepsis evaluation
• Immediate ophtho consult
  • 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

• Conjunctivitis
• Red Eye (Peds)
• Eye Algorithms (Main)

Source

Tintinalli