Neonatal conjunctivitis
Background
- Vesicles + conjunctivitis = full sepsis eval + acyclovir
Clinical Features
Chlamydia
- Can range from mild to severe hyperemia w/ thick mucopurulent discharge
Gonococcal
- May present as typical conjunctivitis or w/ severe lid edema, cornea ulceration
Differential Diagnosis
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
- Leading cause of preventable blindness in the world
Herpetic
- Peaks at 6-14 days of life
- May lead to keratitis and disseminated infection
Diagnosis
- Gram stain/culture to r/o N. gonorrhea vs C. trachomatis
- C. trachomatis will have negative gram stain because it is an intracellular parasite.
Treatment
Prophylaxis
- Erythromycin 0.5% ointment x1 or tetracycline 1% or silver nitrate 1% x1 topical, applied at birth.
Chemical
- Watchful waiting
Gonococcal (onset 2-4 days)
- Cefotaxime 100mg/kg IV or IM OR ceftriaxone 25-50mg/kg IV or IM x1 (not to exceed 125mg)
- Cefotaxime is preferred because it does not displace bilirubin
- Disseminated disease should be suspected until CSF is negative
- Treat mother and partners
- Irrigate eyes with saline (topical antibiotics are insufficient and unnecessary)
Chlamydia (onset 5-10 days)
- Erythromycin ophthalmic ointment plus one of the following
- Azithromycin 20mg/kg PO once daily x 3 days OR
- Erythromycin 50mg/kg PO QD in 4 divided doses x 14 days
- Disease manifests 5 days post-birth to 2 weeks (late onset)
Herpetic (onset 6-14 days)
- Acyclovir 20mg/kg IV q8hr x 14-21d
- Topical antiviral
- Do not give steroids
- Full neonatal sepsis evaluation
- Immediate ophtho consult
Disposition
- Gonococcal
- Admit
- Herpetic
- Admit
See Also
Source
Tintinalli