Neonatal conjunctivitis

This page is for neonatal patients; for non-neonatal pediatric see conjunctivitis (peds) and adult patients see conjunctivitis

Background

  • Vesicles + conjunctivitis = full sepsis eval + acyclovir

Types

Chemical

  • Historically due to ocular prophylaxis with silver nitrate
  • Occurs on 1st day of life
  • Less common now with erythromycin ointment replacing silver nitrate

Gonococcal

  • Peaks at 3-5 days after birth
  • Has potential to cause loss of vision
  • Hyperpurulent

Chlamydia

  • Peaks from 1wk to 1 month after birth
  • Leading cause of preventable blindness in the world
  • May present with otitis and pneumonia with staccato cough

Herpetic

  • Peaks at 6-14 days of life
  • May lead to keratitis and disseminated infection

Streptococcus/S. Aureus

  • 5 wks to 5 yrs

Clinical Features

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

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 3-10 days)

  • 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 (onset 6-14 days)

  • Acyclovir 20mg/kg IV q8hr x 14-21d
  • Topical antiviral
  • Full neonatal sepsis evaluation
  • Immediate ophtho consult

Disposition

  • Gonococcal
    • Admit
  • Herpetic
    • Admit

See Also

References