Neonatal conjunctivitis

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Neonatal conjunctivitis or ophthalmia neonatorum is an acute purulent conjunctivitis during the first month of life. It is usually contracted from infected genital secretions of the mother. 

Cleaning of the neonate’s eyes immediately after birth and the application of 1% tetracycline ointment into the eyes, is effective in preventing the condition. This must be implemented as a policy in all health facilities in which child deliveries are undertaken.

Cause

  • Neisseria gonorrhoea
  • Chlamydia trachomatis
  • Staphylococci
  • Streptococci
  • Herpes Simple virus
  • Chemical e.g. silver nitrate 

Symptoms

  • Eye discharge
  • Swelling of the eye lids

Signs

  • Eye discharge, which may be purulent
  • Redness and swelling of the conjunctivae
  • Oedema and redness of the eyelids

Investigations

  • Conjunctival swabs for Gram staining and culture 

TreatmentTreatment Objectives

  • To treat the infection
  • To prevent blindness 

Non-pharmacological treatment

Clean the eyelids frequently (every 2 hours) with cotton wool dipped in sterile saline solution. In the absence of sterile saline solution, use boiled water that has been left to cool.

Pharmacological treatment  Treatment of baby

Evidence Rating: [B]

  • Ceftriazone, IM or IV, 50 mg/kg stat. (max.125 mg) 

Or

  • Cefotaxime, IM, 100 mg/kg stat.

And

  • Erythromycin, oral, 12.5 mg/kg 6 hourly for 14 days

And

  • Chloramphenicol eye drops, 0.5% applied to each eye every 2 hours for 48 hours (after cleaning away discharge-saline irrigation)

Then

  • Chloramphenicol eye drops, 0.5% applied to each eye 6 hourly 

And 

  • Chloramphenicol eye ointment, 1% applied to each eye at night 

Treatment of mother 

Evidence Rating: [A]

  • Ceftriaxone, IM, 250 mg stat.                                                       

And

  • Erythromycin, oral, 500 mg 6 hourly for 7 days

Treatment of mother’s partner(s) for gonorrhoea and chlamydia

  • Ceftriaxone, IM, 250 mg stat.

Or

  • Cefixime, oral, 400 mg stat.

Or

  • Ciprofloxacin, oral, 500 mg stat.

And

  • Doxycycline, oral, 100 mg 12 hourly for 7 days

Or

  • Tetracycline, oral, 500 mg 6 hourly for 7 days

Or

  • Erythromycin, oral, 500 mg 6 hourly for 7 days

Or 

  • Azithromycin, oral, 1 g stat.

Referral Criteria

  • Refer all neonates with corneal involvement and or severe neonatal conjuctivitis not responding to treatment to a paediatrician and or an ophthalmologist.