By ULY CLINIC

Ophthalmia Neonatorum/Neonatal Conjunctivitis

Introduction

This is acute bacterial infection of the eyes that affect newborn baby during the first 28 days of life. The infection is acquired from mother’s birth canal secretions. It is characterized by inflammation of the conjunctivae, sticky eyes to abundant purulent discharge and eyelids oedema.

Causative organisms are Neisseria gonorrhoea, Chlamydia spp and Staphylococcus spp.

Diagnostic Criteria

Patients present with massive edema and redness of eyelids and with purulent and copious discharge from the eyes, clinical presentation ranges from mild (small amount of sticky exudates) to severe form (profuse pus and swollen eye lids) depending on the causative organism
There is usually rapid ulceration and perforation of corneal which eventually leads to blindness if treatment is delayed
It usually presents 3–4 days of life
Late and mild presentation is due to Staphylococcus or undefined
Treat parents of a neonate with purulent discharge appropriately

Non-Pharmacological Treatment

Cleanse or wipe eyes of all newborn babies with a clean cloth, cotton wool or swab, taking care not to touch or injure the eye

Pharmacological Treatment

Screen women in the antenatal clinics and treat both parents for Sexually Transmitted Diseases. In Ophthalmia neonatorum, prevention is better than cure.

Apply Chloramphenicol 1% eye ointment to all newborn babies as soon as possible after birth.

Sticky eye(s) without purulent discharge:

Chloramphenicol 1% eye ointment, apply 6 hourly for 7 days

Purulent discharge

Mild discharge without swollen eyelids and no corneal haziness:
Compound Sodium Lactate eye wash, immediately then 2–3 hourly until discharge clears

AND

Ceftriaxone 50mg/kg IM immediately as a single dose
Given at District Hospital (Treatment to be initiated by Clinical Eye Care Professional eg. Assistant Medical Officer in Ophthalmology)

Cefotaxime 50mg/kg IM immediately as a single dose
Abundant purulent discharge and/or swollen eyelids and /or corneal haziness:
Compound Sodium Lactate eye wash, immediately then hourly until referral
Ceftriaxone 50mg/kg IM immediately as a single dose

Cefotaxime 50mg/kg IM immediately as a single dose

Referral:

to Regional and Specialised Hospital.

Note:

Ceftriaxone should not be used in neonates that are seriously ill or are jaundiced
Ceftriaxone should not be administered if calcium containing intravenous infusion e.g Compound Sodium Lactate is given or is expected to be given

Treat both parents of newborns who develop purulent conjunctivitis after 24 hours of birth for N-gonorrhea and Chlamydia with

Ceftriaxone250 mg IM as a single dose

For Ceftriaxone IM injection: Dissolve Ceftriaxone 250 mg in 0.9 mL

Lidocaine 1% without epinephrine (adrenaline)

AND

Azithromycin, oral, 1 g as a single dose

NOTE For more details on prevention and treatment see the “Neonatal Conjuctivitis (NC) Flow chart number 12.7 under the Sexual Transmmited disease chapter

Referral: Urgently

Neonates with abundant purulent discharge and/or swollen eyelids and/or corneal haziness and Neonates unresponsive to treatment within 2 days.

Updated on, 2.11.2020

References

1. STG

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