- 1.
How does ophthalmia neonatorum typically present?
Inflammation of the conjunctiva within the first month of life is classified as ophthalmia neonatorum (neonatal conjunctivitis). A purulent or mucoid discharge from one or both eyes is present. In addition to conjunctival injection, edema and erythema of the lids are often present.
- 2.
What is the usual means of transmission for neonatal conjunctivitis?
Conjunctivitis is usually transmitted to the newborn by passage through the mother’s infected cervix at the time of delivery and reflects the sexually transmitted infections prevalent in the community. The organisms can ascend into the uterus as well, and so may cause conjunctivitis even in the setting of cesarean section. It may also be spread by people handling the baby soon after birth.
- 3.
What is the most common cause of neonatal conjunctivitis in the United States?
Neonatal conjunctivitis is the most common ocular disease of newborns. It is most often caused by Chlamydia trachomatis (6.2/1000 live births). One hundred years ago Neisseria gonorrhoeae was the leading cause of blindness in infants. Today gonococcal conjunctivitis is seen less in industrialized nations (3/1000 live births) because of neonatal ocular prophylaxis and better prenatal screening.
- 4.
List the common causes of ophthalmia neonatorum, their usual clinical presentations, and their approximate times of onset after birth.
See Table 9-1 .
Table 9-1
Common Causes of Ophthalmia Neonatorum with Time of Onset and Typical Characteristics
Type
Time of Onset
Typical Characteristics
Chemical (e.g., silver nitrate drops)
Within hours of instillation
Self-limiting, mild, serous discharge (occasionally purulent)
Lasts 24-36 h
Chlamydia trachomatis
5-14 days
Mild-to-moderate, thick, purulent discharge (severity is variable)
Erythematous conjunctiva, with palpebral more than bulbar involvement
Neisseria gonorrhoeae
24-48 h
Hyperacute, copious, purulent discharge
Lid swelling and chemosis common
Bacterial (nongonococcal) ∗
After 5 days
Variable presentation, depending on organism
Herpetic
Within 2 weeks
Conjunctiva only mildly injected
Serosanguineous discharge
Vesicular rash on lids sometimes seen
Most have concomitant systemic herpetic disease
∗ Staphylococcus aureus , Staphylococcus epidermidis , Streptococcus pneumoniae , Streptococcus viridans , Haemophilus influenzae , Escherichia coli , Pseudomonas aeruginosa .
- 5.
What type of neonatal conjunctivitis is associated with the most severe complications to the eye?
N. gonorrhoeae has the ability to penetrate intact epithelial cells and divide within them. Its onset is rapid and can quickly lead to corneal perforation and endophthalmitis.
- 1.
Chemical
- 2.
Chlamydial
- 3.
Gonococcal
- 4.
Bacterial
- 5.
Herpetic
- 6.
What other diagnostic tool is used to differentiate the various causes of neonatal conjunctivitis?
In most cases one cannot rely solely on clinical characteristics and time of onset for accurate diagnosis; therefore, initial therapy is also based on the results of Gram and Giemsa stains performed immediately on conjunctival swabs and scrapings. Their classic characteristics are listed in Table 9-2 . However, classic findings are not seen in all cases. Specimens are also sent for culture and sensitivity testing and antigen detection tests. Treatment regimens are adjusted accordingly once the results are known, and clinical response is observed. Polymerase chain reaction is likely to play an increasing role in the identification of pathogens causing conjunctivitis because of its high sensitivity and specificity.
Table 9-2
Gram and Giemsa Stain Findings with Various Causes of Neonatal Conjunctivitis
