Neonatal conjunctivitis is a form of conjunctivitis which affects newborn babies following birth. It is typically due to neonatal bacterial infection, although can also be non-infectious. Infectious neonatal conjunctivitis is typically contracted during vaginal delivery from exposure to bacteria from the birth canal, most commonly Neisseria gonorrhoeae or Chlamydia trachomatis. Antibiotic ointment is typically applied to the newborn's eyes within 1 hour of birth as prevention for gonococcal ophthalmia. This practice is recommended for all newborns and most hospitals in the United States are required by state law to apply eye drops or ointment soon after birth to prevent the disease. If left untreated, neonatal conjunctivitis can cause blindness.
Neonatal conjunctivitis by definition presents during the first month of life. Signs and symptoms include:
Pain and tenderness in the eyeball
Conjunctival discharge: purulent, mucoid or mucopurulent
Conjunctival hyperaemia and chemosis, usually also with swelling of the eyelids
Corneal involvement may occur in herpes simplex ophthalmia neonatorum
Time of onset
Chemical causes: Right after delivery Neisseria gonorrhoeae: Delivery of the baby until 5 days after birth Chlamydia trachomatis: 5 days after birth to 2 weeks
Complications
Untreated cases may develop corneal ulceration, which may perforate, resulting in corneal opacification and staphyloma formation.
Cause
Non-infectious
Chemical irritants such as silver nitrate can cause chemical conjunctivitis, usually lasting 2–4 days. Thus, prophylaxis with a 1% silver nitrate solution is no longer in common use. In most countries, neomycin and chloramphenicol eye drops are used, instead. However, newborns can suffer from neonatal conjunctivitis due to reactions with chemicals in these common eye drops. Additionally, a blocked tear duct may be another noninfectious cause of neonatal conjunctivitis.
Infectious
The two most common infectious causes of neonatal conjunctivitis are N. gonorrheae and Chlamydia, typically acquired from the birth canal during delivery. However, other different bacteria and viruses can be the cause, including herpes simplex virus, Staphylococcus aureus, Streptococcus pyogenes, and Streptococcus pneumoniae. Ophthalmia neonatorum due to gonococci typically manifests in the first 5 days after birth and is associated with marked bilateral purulent discharge and local inflammation. In contrast, conjunctivitis secondary to infection with C. trachomatis produces conjunctivitis 3 days to 2 weeks after delivery. The discharge is usually more watery in nature and less inflamed. Babies infected with chlamydia may develop pneumonitis at a later stage. Infants with chlamydia pneumonitis should be treated with oral erythromycin for 10–14 days. Diagnosis is performed after taking swab from the infected conjuctivae.
Prevention
Antibiotic ointment is typically applied to the newborn's eyes within 1 hour of birth as prevention against gonococcal ophthalmia. This may be erythromycin, tetracycline, or rarely silver nitrate or Argyrol.
Treatment
Prophylaxis needs antenatal, natal, and postnatal care.
Antenatal measures include thorough care of mother and treatment of genital infections when suspected.
Natal measures are of utmost importance, as most infection occurs during childbirth. Deliveries should be conducted under hygienic conditions taking all aseptic measures. The newborn baby's closed lids should be thoroughly cleansed and dried.
If the cause is determined to be due to a blocked tear duct, a gentle palpation between the eye and the nasal cavity may be used to clear the tear duct. If the tear duct is not cleared by the time the newborn is 1 year old, surgery may be required.
Postnatal measures include:
* Use of 1% tetracycline ointment, 0.5% erythromycin ointment, or 1% silver nitrate solution into the eyes of babies immediately after birth
Other bacterial ophthalmia neonatorum should be treated by broad-spectrum antibiotics drops and ointment for 2 weeks.
Neonatal inclusion conjunctivitis caused by C. trachomatis should be treated with oral erythromycin. Topical therapy is not effective and also does not treat the infection of the nasopharynx.
The disease incidence varies widely depending on the geographical location. In addition to the incidence of this sight-threatening infection, Dharmasena et al also investigated the time trends of the disease. According to them, the incidence of neonatal conjunctivitis in England was 257 per 100,000 in 2011.
