Neonatal conjunctivitis: Difference between revisions
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''This page is for neonatal patients; for non-neonatal pediatric see [[conjunctivitis (peds)]] and adult patients see [[conjunctivitis]]'' | |||
==Background== | ==Background== | ||
* | *Neonatal conjunctivitis = ophthalmia neonatorum | ||
*First 30 days of life | |||
*Chemical, Gonococcal, Chlamydial, other bacterial, and viral | |||
== | ===Types=== | ||
* | ====Chemical==== | ||
**Can range from mild to severe hyperemia | *Historically due to ocular prophylaxis with silver nitrate | ||
*Occurs on 1st day of life, resolves within 48 hrs | |||
*Less common now with [[erythromycin]] ointment replacing [[silver nitrate]] | |||
== | |||
*Gram stain/culture to | ====[[Gonococcal]]==== | ||
*Presents at 2-7 days of life (peak 3-5) | |||
*Bilateral conjunctival erythema, chemosis | |||
*Copious purulent discharge | |||
*Has potential to cause loss of vision | |||
====[[Chlamydia]]==== | |||
*Similar exam to gonoccocal but starts at 7-14 days of age | |||
*Peaks from 1wk to 1 month after birth | |||
*Leading cause of preventable blindness in the world | |||
*May present with otitis and chlamydial pneumonia with staccato cough | |||
====[[Herpes|Herpetic]]==== | |||
*Peaks at 6-14 days of life | |||
*Presents with inflammation and edema, less likely purulence | |||
*Look for other mucocutaneous lesions and assess mother for herpes | |||
*May lead to keratitis and disseminated infection | |||
*Vesicles + conjunctivitis = acyclovir + full sepsis w/u, including for disseminated herpes | |||
====[[Streptococcus]]/[[S. Aureus]]==== | |||
*5 weeks to 5 yrs | |||
==Clinical Features== | |||
[[File:Gonococcal ophthalmia neonatorum.jpg|thumb|Gonococcal ophthalmia neonatorum]] | |||
===[[Chlamydia]]=== | |||
*Can range from mild to severe hyperemia with thick mucopurulent discharge | |||
===[[Gonococcal]]=== | |||
*May present as typical conjunctivitis or with severe lid edema, cornea ulceration | |||
==Differential Diagnosis== | |||
{{Neonatal eye problems DDX}} | |||
==Evaluation== | |||
*Gram stain/culture to rule out N. gonorrhea vs C. trachomatis | |||
**C. trachomatis will have negative gram stain because it is an intracellular parasite. | **C. trachomatis will have negative gram stain because it is an intracellular parasite. | ||
== | ==Management== | ||
{{Neonatal conjunctivitis treatment}} | |||
NB: | |||
* | *For conjunctivitis starting >2 weeks of age, most likely pathogens include S. aureus, S. epi, E. coli, pseudomonas, and non-typable H. Flu. | ||
*No systemic therapy necessary, treat w/ bacitracin-polymyxin ointment | |||
* | |||
==Disposition== | ==Disposition== | ||
*Gonococcal | *Gonococcal | ||
**Admit | **Admit all infants for evaluation of disseminated disease (BCx, UA/UCx, CSF) and ophthalmology consult given high risk | ||
*Herpetic | *Herpetic | ||
**Admit | **Admit | ||
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==See Also== | ==See Also== | ||
*[[Conjunctivitis]] | *[[Conjunctivitis]] | ||
{{Eye algorithms}} | |||
==References== | |||
<references/> | |||
[[Category: | [[Category:Pediatrics]] | ||
[[Category: | [[Category:Ophthalmology]] | ||
[[Category:ID]] |
Latest revision as of 17:14, 5 October 2019
This page is for neonatal patients; for non-neonatal pediatric see conjunctivitis (peds) and adult patients see conjunctivitis
Background
- Neonatal conjunctivitis = ophthalmia neonatorum
- First 30 days of life
- Chemical, Gonococcal, Chlamydial, other bacterial, and viral
Types
Chemical
- Historically due to ocular prophylaxis with silver nitrate
- Occurs on 1st day of life, resolves within 48 hrs
- Less common now with erythromycin ointment replacing silver nitrate
Gonococcal
- Presents at 2-7 days of life (peak 3-5)
- Bilateral conjunctival erythema, chemosis
- Copious purulent discharge
- Has potential to cause loss of vision
Chlamydia
- Similar exam to gonoccocal but starts at 7-14 days of age
- Peaks from 1wk to 1 month after birth
- Leading cause of preventable blindness in the world
- May present with otitis and chlamydial pneumonia with staccato cough
Herpetic
- Peaks at 6-14 days of life
- Presents with inflammation and edema, less likely purulence
- Look for other mucocutaneous lesions and assess mother for herpes
- May lead to keratitis and disseminated infection
- Vesicles + conjunctivitis = acyclovir + full sepsis w/u, including for disseminated herpes
Streptococcus/S. Aureus
- 5 weeks to 5 yrs
Clinical Features
Chlamydia
- Can range from mild to severe hyperemia with thick mucopurulent discharge
Gonococcal
- May present as typical conjunctivitis or with severe lid edema, cornea ulceration
Differential Diagnosis
Neonatal eye problems
- Nasolacrimal duct obstruction
- Dacrocystitis
- Conjunctivitis
- Chemical
- Gonococcal
- Chlamydia
- Herpetic
- Streptococcus/S. Aureus
- Early onset glaucoma
- Uveitis
- Ocular foreign body
- Corneal abrasion
- Ocular trauma
- Ingrown eyelash
Evaluation
- Gram stain/culture to rule out N. gonorrhea vs C. trachomatis
- C. trachomatis will have negative gram stain because it is an intracellular parasite.
Management
Prophylaxis
- Erythromycin 0.5% ointment x1 or tetracycline 1% or silver nitrate 1% x1 topical, 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
NB:
- For conjunctivitis starting >2 weeks of age, most likely pathogens include S. aureus, S. epi, E. coli, pseudomonas, and non-typable H. Flu.
- No systemic therapy necessary, treat w/ bacitracin-polymyxin ointment
Disposition
- Gonococcal
- Admit all infants for evaluation of disseminated disease (BCx, UA/UCx, CSF) and ophthalmology consult given high risk
- Herpetic
- Admit
See Also
Eye Algorithms
- Red eye
- Periorbital swelling
- Acute vision loss (noninflamed)
- Acute onset flashers and floaters
- Painful eyes with normal exam