Neonatal Conjunctivitis

 

Reviewed by Simon Rowley and Lesley Voss
November
2013
Clinical Guidelines Back Newborn Services Home Page
Demographics Diagnosis Causes References Antibiotics

Incidence

Presentation

History

Maternal history

Diagnosis

Bacterial culture
  • Do this first unless Chlamydia is strongly suspected
  • if Gram stain finds Gram -ve bacilli, seriously consider Pseudomonas and consider sepsis screen and parenteral anti-Pseudomonal antibiotics
  • Swab for MC & S (standard blue swab).
  • Ask lab to process urgent gram stain for gonococcus if suspected. In working hours a special swab can be used to test for N.gonorrhea
  • if Gram stain finds Gram -ve bacilli, seriously consider Pseudomonas and consider sepsis screen and parenteral anti-Pseudomonal antibiotics
     

 

  • PCP (BD probe tec swabs). Can also be used for Chlamydia (use small blue).
Chlamydia
  • Tends to present between days 5-14.
 
  • Swab as above (Chlamydia PCR).
Viral Conjunctivitis, Adenovirus, Enterovirus and HSV
  • Green viral culture swab for HSV(processed 5 days/week).

NB: Transport all specimens ASAP to Microbiology Laboratory, LabPlus.

Causes

Non-Infectious
  • Nasolacrimal duct obstruction may cause ‘sticky’ eyes.
  • Corneal abrasion following trauma at delivery.
  • Glaucoma (watch for corneal clouding or proptosis, is associated with portwine stains in the ophthalmic region).
  • Foreign body.
Infectious Organism Age of Onset Clinical Features Therapy
Staphylococcus aureus
Streptococcus pneumoniae, Haemophilus spp,
Enterococci

2-5 days

Unilateral, crusted purulent discharge Topical Framycetin (soframycin) drops qds for 5 days
Neisseria gonorrhoeae #

Infants who are positive need to be evaluated for disseminated infections

3 days to 3 weeks

Bilateral, hyperaemic, chemosis, copious thick white discharge Ceftriaxone 50mg/kg IV/IM as a single dose (maximum 125mg),

Saline irrigations hourly until exudate resolves.

Pseudomonas aeruginosa +

5-18 days

Oedema and erthyema of lid, purulent discharge.

IV anti-pseudomonal antibiotics.

Topical Gentamicin.

Chlamydia trachomatis *

5-14 days

Unilateral or bilateral, mild conjunctivitis, copious purulent discharge. PO erythromycin 50mg/kg/day x 14d (qid)Alternative, 5 days Azithromycin syrup
(= pertussis dosing 10mg/kg/day and 5mg/kg day 2-5)
Herpes simplex   Conjunctivitis with vesicles elsewhere

Need ophthalmology review within 24 hours.

Acyclovir 30mg/kg/day IV tid x 14-21d.

Topical acyclovir 3% 5 times daily.

Isolation.

# Uncommon, potential for serious consequences - severe keratitis and endophthalmitis. Requires early recognition and treatment. Needs blood and CSF culture. Consider concomitant chlamydial infection if poor response to cephalosporin. Parents require investigation and screening.

+ Risk of rapid progression from purulent discharge to denuding of corneal epithelium, and perforation of cornea. The anterior chamber can fill with fibrinous exudate, iris can adhere to cornea and later blood vessel invasion. The late ophthalmic complications can be followed by bacteraemia and septic foci.

* Most common pathogen, 20-50% of exposed infants will develop chlamydia conjunctivitis, 10-20% will develop pneumonia. If relapse occurs repeat course of erythromycin for further 14 days. Parents require treatment.
NB:
Chloramphenicol in topical therapy can obscure results of tests for chlamydia.

In cases of Chlamydia/N.gonorrhea, the LMC (midwife) needs to be informed.

Antibiotic Eye Preparations

Generic Name

Trade Name and Preparation

Usual susceptibility

Potential Adverse Effects

Staphylococci

Steptococci

Gram negative bacilli

Pseudomonas

Chloramphenicol 0.5% QDS for 5 days Chlomin drops, ointment
Chloromycetin drops, ointment
Chloroptic drops, ointment
Chlorsig drops, ointment
Minims drops

+

+

+

-

May obscure results of tests for Chlamydia; rarely marrow aplasia.

Framycetin
(Soframycin)
Framycetin 5% drops, ointment

+

+

-

-

May obscure results of tests for Chlamydia; rarely ototoxicity or marrow aplasia.

Fusidic acid (Sodium fusidate) Fucithalmic 1% drops

+

-

+

-

Rarely transient stinging.

Gentamicin Genoptic 0.3% drops
Minims drops

+

-

+

+

Sensitisation; development of resistant organisms.

Sulphacetamide Acetopt drops
Bleph 10% Liquifilm drops
Minims drops

+

+

+

-

Inactivated by pus and tissue breakdown products.

 

References

1 Red Book 2012 Report of the Committee on Infectious Diseases, American Academy of Paeds.
2 Remington and Klein. Infectious diseases of the fetus and newborn. 4th Ed. 1995.
  Starship Children’s Health Guidelines, Infections in and around the eye.