Neonatal conjunctivitis

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Background

  • Vesicles + conjunctivitis = full sepsis eval + acyclovir

Diagnosis

  • Chlamydial
    • Can range from mild to severe hyperemia w/ thick mucopurulent discharge
  • Gonococcal
    • May present as typical conjunctivitis or w/ severe lid edema, cornea ulceration

Work-Up

  • Gram stain/culture to r/o gonorrhea

DDx

  • Chemical
    • Due to ocular prophylaxis
    • Occurs on 1st day of life
  • Gonococcal
    • Peaks at 3-5 days after birth
    • Has potential to cause loss of vision
  • Chlamydia
    • Peaks from 1wk to 1 month after birth
  • Herpetic
    • Peaks at 6-14 days of life
    • May lead to keratitis and disseminated infection

Treatment

  • Gonococcal
    • Cefotaxime 100mg/kg IV or IM OR ceftriaxone 25-50mg/kg IV or IM x1 (not to exceed 125mg)
      • Cefotaxime is preferred b/c does not displace bilirubin
    • Disseminated disease should be suspected until CSF is negative
    • Topical tx is unnecessary
  • Chlamydial
    • Erythromycin 50mg/kg PO QD in 4 divided doses x 14 days
    • Topical tx is unnecessary
  • Herpetic
    • Acyclovir 20mg/kg IV q8hr x 14-21d
    • Topical antiviral
    • Full sepsis evaluation
  • Chemical
    • Watchful waiting

Disposition

  • Gonococcal
    • Admit
  • Herpetic
    • Admit

See Also

Source

Tintinalli