• Newborn Conjunctivitis

    (Ophthalmia Neonatorum; Neonatal Conjunctivitis)

    Definition

    Ophthalmia neonatorum is conjunctivitis that occurs in a newborn. Conjunctivitis is an inflammation of the surface or covering of the eye. Any eye infection that occurs in the first month of a baby’s life can be classified as ophthalmia neonatorum.
    Conjunctivitis
    Inflamed conjunctiva
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    Causes

    The cause of the conjunctivitis may be an irritation in the eye or a blocked tear duct. In some cases, the irritation may be from the antibiotic given after delivery.
    Bacteria can also cause an infection in the eye. The most common types of bacteria that cause infection in the infant’s eye come from the mother’s birth canal, and are passed to the infant during delivery. These infections can include:
      Sexually transmitted diseases (STDs)—The most common bacteria passed to infants during delivery are due to STDs from the mother’s birth canal. If untreated, many of these infections can cause serious damage to the infant’s eye. STDs that can cause eye damage include:
    • Skin bacteria such as Staphylococcus aureus
    • Bacteria from the mother’s gastrointestinal tract, such as Pseudomonas or Klebsiella

    Risk Factors

    The biggest risk factor for developing ophthalmia neonatorum is a maternal infection or STD at the time of delivery. The mother may not have any symptoms during delivery and still be able to transmit the infection. If you are pregnant, it is important to discuss any STDs that you have or had in the past. You and your doctor can develop a plan to protect your baby from infections during delivery.

    Symptoms

    The most common symptoms are redness and swelling of the conjunctiva in the newborn. If your baby has this or any of these other symptoms, see your baby's pediatrician:
    • Drainage and discharge from the eye; it may be watery or thick and pus-like
    • Swollen eyelids

    Diagnosis

    If your baby’s pediatrician suspects ophthalmia neonatorum, an eye examination will be done. The doctor will look at your baby’s eyes to check for anything that may be irritating the eye, and to see if any damage has occurred. The doctor may also want to take a sample of any discharge to determine what type of bacteria or virus is causing the infection.

    Treatment

    Since the potential for serious eye damage to the infant is so great, it is standard treatment in US hospitals to give infants antibiotic eye drops or ointment right after delivery. This helps prevent the development of an eye infection even if the mother shows no symptoms of infection.
    In cases where conjunctivitis does develop, the treatment of ophthalmia neonatorum depends on the cause:

    Blocked Tear Duct

    In cases of ophthalmia neonatorum that are due to a blocked tear duct, the doctor may recommend warm compresses and gentle massage to the area to help unclog the duct.

    Irritation

    Ophthalmia neonatorum due to irritation usually improves on its own in a few days. In some cases, the irritation may be from the antibiotic given after delivery. Silver nitrate, which was often used in the past to prevent eye infection, can cause irritation in the baby’s eye. Many hospitals now use other types of antibiotics to avoid this irritation.

    Bacteria

    Infants that have an eye infection due to bacteria are given antibiotics. These antibiotics may be given as topical drops or ointments, orally, or as an injection. In addition, the eye may be washed to remove the discharge.
    Fortunately, since hospitals today have such effective prevention measures, bacterial cases of ophthalmia neonatorum are rare. And when they do occur, they are usually identified quickly. Antibiotic treatment is very effective and the infection resolves quickly. If you suspect that your infant may have an infection in the eye, it is important to call your baby’s doctor as soon as possible to receive prompt treatment.

    Prevention

    Prevention methods for ophthalmia neonatorum include:
    • Antibiotic eye ointment given to the infant after birth
    • Treating the mother for any STDs prior to labor and delivery
    • A cesarean section for mothers with active genital herpes lesions
    An open, honest relationship with your doctor is important during your pregnancy. Disclosure of your full medical history can help protect your baby from infection.

    RESOURCES

    American Academy of Pediatrics http://www.healthychildren.org

    American Association for Pediatric Ophthalmology and Strabismus http://www.aapos.org

    CANADIAN RESOURCES

    About Kids Health http://www.aboutkidshealth.ca

    Caring for KidsCanadian Paediatric Society http://www.caringforkids.cps.ca

    References

    Akera C, Ro S. Medical concerns in the neonatal period. Clinics in Family Practice . 2003;5(2):265-292.

    Mandell GI, JE Bennett, Dolin R. Principles and Practice of Infectious Disease . 6th ed. Churchill Livingstone; 2004.

    Ophthalmia neonatorum. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated February 3, 2012. Accessed February 19, 2013.

    RE Behrman, RM Kliegman, HB Jenson. Nelson Textbook of Pediatrics . 17th ed. Philadelphia, PA: Saunders; 2004.

    RM Kleigman, RE Behrman, HB Jenson, BF Stanton. Nelson Textbook of Pediatrics . 18th Edition. Eds. Saunders Publishers, Philadelphia PA, 2007.

    Rubenstein JB, Jick SL. Disorders of the conjunctiva and limbus. Ophthalmology . 2nd ed. Mosby: New York; 2004.

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