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

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
  • 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