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DEFINITIONS AND EPIDEMIOLOGY

Neonatal conjunctivitis (ophthalmia neonatorum) is defined as conjunctivitis that occurs in the first 4 weeks of life. Neonatal conjunctivitis has been associated with a wide variety of organisms that have varied in their relative importance over time and geographic location (Table 23-1).

TABLE 23-1Causes of Neonatal Conjunctivitis

Neonatal ocular prophylaxis and routine screening and treatment of pregnant women for gonorrhea and Chlamydia trachomatis infection have altered the epidemiology of ophthalmia neonatorum in the United States.1,2 In the nineteenth century, gonococcal ophthalmia was an important cause of blindness in infants; today, it is rare in industrialized nations, although it remains a serious problem in many developing countries.3–7 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.1 Screening and treatment of pregnant women has 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 remains the most frequent cause of neonatal conjunctivitis.3,8

MAJOR CAUSES OF NEONATAL CONJUNCTIVITIS

Neisseria gonorrhoeae

The population at highest risk for gonococcal conjunctivitis is neonates born to mothers with lower genital tract infection. The transmission rate in neonates born to infected mothers who have not received ocular prophylaxis may be as high as 42%.6 Neonatal gonococcal ophthalmia (Figure 23-1) may appear in conjunction with primary disease at other mucous membrane sites or with systemic disease. Gonococcal conjunctivitis in the newborn usually produces an acute purulent conjunctivitis that appears within 2–7 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 later than 5 days after birth. Permanent corneal damage following gonococcal ophthalmia neonatorum was common in the pre–antibiotic era.1

FIGURE 23-1.

Gonococcal ophthalmia. Profuse mucopurulent discharge in a 5-day-old newborn. Note erythema ...

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