Neonatal conjunctivitis (ophthalmia neonatorum or neonatal blennorrhea) is a conjunctivitis that occurs in the first 4 weeks of life. It is the most common ocular disease of newborns, occurring in 1.6–12% of neonates. Neonatal conjunctivitis has been associated with a wide variety of organisms, which have varied in their relative importance over time and geographic location (Table 20–1). The introduction of neonatal ocular prophylaxis and the introduction of routine screening and treatment of pregnant women for gonorrhea and, more recently, Chlamydia trachomatis infection have altered the epidemiology of ophthalmia neonatorum in the United States.3,4 In the nineteenth century, gonococcal ophthalmia was an important cause of blindness in infants; today, it is relatively uncommon in industrialized nations, although it remains a serious problem in many developing countries.1,5–8 Before the introduction of systematic screening and treatment of C. trachomatis infection in pregnant women in the 1990s, C. trachomatis was the most frequent identifiable infectious cause of neonatal conjunctivitis in the United States.3 Screening and treatment of pregnant women have resulted in a dramatic decrease in perinatal chlamydial infections. However, in countries where pregnant women are not routinely screened, including the Netherlands and many developing countries, C. trachomatis still remains the most frequent cause of neonatal conjunctivitis.2,5
Table 20–1. Infectious Causes of Neonatal Conjunctivitis |Favorite Table|Download (.pdf)
Table 20–1. Infectious Causes of Neonatal Conjunctivitis
Viridans streptococci (S. mitis and S. sanguis)
Herpes simplex virus
The main population at risk of gonococcal conjunctivitis is neonates born to mothers with vaginal infection. The transmission rate in neonates born to infected mothers who have not received ocular prophylaxis may be as high as 42%.1 Neonatal gonococcal ophthalmia (Figure 20–1) may cause primary disease at other mucous membrane sites or systemic disease. Gonococcal conjunctivitis in the newborn usually produces an acute purulent conjunctivitis that appears from 2 to 7 days after birth, although presentations during the second week of life are commonly described. Presentation may be earlier if there has been premature rupture of membranes, but the initial course may, occasionally, be indolent, with onset occurring later than 5 days after birth. Permanent corneal damage following gonococcal ophthalmia neonatorum was usual in the preantibiotic era.3
Gonococcal ophthalmia. Profuse mulo-purulent discharge in a 5-day-old newborn. Note eryhtema and swelling of the LID. (Shah BR, Lucchesi M. Atlas of Pediatric Emergency Medicine, McGraw-Hill.)
C. trachomatis infection is acquired by ...