Chapter 72: Neonatal Conjunctivitis

Patient Story

A 6-day-old girl is admitted to the hospital because of profuse yellowish drainage from both eyes. The infant was born at home after a 36-week gestation age to an 18-year-old mother. Maternal screens were not obtained during pregnancy due to poor prenatal care. On exam, the infant had profuse purulent drainage from both eyes with significant eyelid edema (Figure 72-1). Gram stain of the purulent drainage revealed gram-negative diplococci, consistent with Neisseria gonorrhoeae infection (Figure 72-2). Blood and cerebrospinal fluid cultures were negative. The infant was treated with one dose of intravenous ceftriaxone and frequent eye irrigations and recovered completely.

Introduction

• Neonatal conjunctivitis (Ophthalmia neonatorum) occurs in the first month of life, and may be infectious or noninfectious (chemical) in origin. Knowledge of the differential diagnosis is essential in early diagnosis and management.

Synonyms

Ophthalmia neonatorum, inclusion (chlamydial) conjunctivitis.

Epidemiology

• Most infectious causes are acquired by the neonate during vaginal delivery.

• The risk of a newborn acquiring Chlamydia trachomatis from the infected mother is estimated to be 50 percent; up to half of these may develop conjunctivitis.¹

• The incidence of gonococcal conjunctivitis has decreased dramatically since the introduction of newborn antimicrobial ocular prophylaxis.²

• Skin, eye, and mouth disease represents up to 45 percent of cases of neonatal herpes simplex infection,³ which may present as neonatal conjunctivitis.

Etiology and Pathophysiology

• The most common cause of neonatal conjunctivitis is Chlamydia trachomatis; Other causative agents include N gonorrhoeae and Herpes simplex virus (HSV).⁴

• The role of bacterial agents other than C trachomatis, N gonorrhoeae, and HSV in the etiology of neonatal conjunctivitis is controversial; organisms such as Staphylococcus aureus, Group B Streptococci, and Haemophilus influenzae, which are occasionally isolated from newborns with conjunctivitis have been isolated from the conjunctivae of asymptomatic newborns.¹

• Although rare, nosocomial neonatal conjunctivitis due to Pseudomonas aeruginosa can occur, and is related to prolonged stay in the neonatal intensive care unit.⁵

• Chemical conjunctivitis is a noninfectious cause of neonatal conjunctivitis, which most commonly occurs secondary to silver nitrate infant prophylaxis.

Risk Factors

• Maternal infection with C trachomatis, N gonorrhoeae or HSV, especially during vaginal delivery, is the most important risk factor.⁴

Diagnosis

Clinical Features

• Signs and symptoms vary from mild ...