Neonatal Conjunctivitis

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CLINICAL DESCRIPTION

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. These serious conditions rapidly progress and threaten sight

CLINICAL FEATURESSIGNS AND SYMPTOMS

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

Note: At birth give all neonates a single prophylactic application of tetracycline eye ointment

INVESTIGATIONS

• Conjunctival swabs for Gram staining and culture

TREATMENTNON-PHARMACOLOGICAL

• 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 until the purulent discharge is cleared.
• Admit patient to hospital
• Closely monitor until the infection has resolved

PHARMACOLOGICAL

All parents of infected babies:

• Ceftriaxone 250 mg IM single dose, plus
• Azithromycin 1g orally as single dose

Infants with signs of conjunctivitis:

• Isolate immediately
• Institute a rigorous system of barrier nursing with careful attention to hygiene
• Give Ceftriaxone 50mg/kg IM once and Azithromycin 20mg/kg once a day for 3 days..

Alternatively, for Ceftriaxone,

• Give Cefotaxime 50mg/kg IM as a single dose (maximum 125mg)
• Give Tetracycline eye ointment 1% 6 hourly for 3 days applied in each eye every 6 hours for 3 days
• Clean away any discharge before application
• Treat Father with
  • Ceftriaxone 250mg IM STAT, and
  • Azithromycin 1g as a single dose orally.
• Treat Mother with:
  • Ceftriaxone 250mg IM STAT, and
  • Azithromycin 1g orally as single dose.

Alternative topical agent:

• Gentamycin eye drops 0.3%, 1 to 2 drops into each eye every 2 hours
• Reduce dose frequency as the infection is controlled
• Continue for 48 hours after healing