NEONATAL CONJUNCTIVITIS

(Ophthalmia Neonatorum)

Refers to conjunctival infection of neonates by STI organisms in the infected mother’s birth canal. It is a very serious condition that can lead to corneal ulceration and ultimately to blindness. Blindness in children is associated with high infant morbidity and mortality.

Causes

  • Commonly caused by Neisseria gonorrhoeae and Chlamydia trachomatis
  • Other non-STI causes of neonatal conjunctivitis predisposed by difficult labour such as early rupture of membranes, vacuum extraction or other assisted vaginal delivery

Clinical features

  • Purulent discharge from one or both eyes within 30 days from birth
  • Inflamed and swollen eyelids
  • Complications of untreated conjuctivitis: corneal ulceration, perforation, scarring and blindness

Investigations

  • Pus swab: Gram stain, Culture & Sensitivity

Management

Treatment should cover both gonorrhoea and chlamydia

  • Start cleaning with normal saline and apply tetracycline ointment every hour while referring for systemic treatment
  • Ceftriaxone 125 mg single dose IM plus azithromycin syrup 20 mg/kg orally, once daily for 3 days
  • Irrigate the eyes with saline or sterile water
  • Use gloves and wash hands thoroughly after handling the eyelids
  • Cover the eye with gauze while opening the eyelid as pus may be under pressure
  • Topical tetracycline eye ointment has NO added benefit in active disease
  • Treat both parents for Gonorrhoea and Chlamydia and screen for HIV and syphilis

Prevention

  • Screen and treat all infected mothers in antenatal care
  • Apply prophylactic tetracycline eye ointment 1% to both eyes of ALL newborns at the time of delivery