Ophthalmia Neonatorum

N. gonorrhoeae

• Presents in the first 4 days of life, usually within 1st 48 hours
• Highly purulent discharge with redness and swelling of the eye lids
• EMERGENCY! Rapidly progressive to corneal ulceration and perforation.
• Diagnosis by gram stain conjunctival scrapings & culture
• Risk for more serious infection-need systemic treatment (other sites can include: Other sites (scalp abscess, vaginitis, disseminated disease)

C. trachomatis

• Most common cause of neonatal conjunctivitis.
• Acquired during passage through the birth canal
• Occurs after 4 days to the first several weeks of life
• Bilateral, around 4-10 days after birth
• Initially watery discharge becomes purulent.
• Dx: conjunctival scrapings
• Complications: Pseudomenbranous conjunctivitis.

Ppx: Newborn treatment with silver nitrate (or erythromycin or tetracycline) is intended to prevent gonococcal ophthalmia. Topical prophylaxis for gonorrhea has not been confirmed by clinical studies to prevent chlamydia infection.

Treatment

• SYSTEMIC antibiotics!!!
• Chlamydia: Oral erythromycin for 2 weeks. (topical RX not effective). Failure rate of 10-20% with Erythromycin often require second course of antibiotics 
• Gonococcal: IV Cefotaxime + topical Erythromycin (ppx silver nitrate, erythro, or tetracycline)

CHLA Board Review 2005