Ophthalmia neonatorum: Difference between revisions

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__NOTOC__
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[[Image:220px-Gonococcal_ophthalmia_neonatorum.jpg|thumb|right|Neonatal conjunctivitis<ref> Centers for Disease Control and Prevention's Public Health Image Library[https://en.wikipedia.org/wiki/Neonatal_conjunctivitis#/media/File:Gonococcal_ophthalmia_neonatorum.jpg]</ref>]]
[[Image:220px-Gonococcal_ophthalmia_neonatorum.jpg|thumb|right|Source: https://www.cdc.gov/]]
{{Ophthalmia neonatorum}}
{{Ophthalmia neonatorum}}
{{SI}}
{{SI}}
{{CMG}}; {{AE}} {{SaraM}}
{{CMG}}; {{AE}} {{SaraM}}


{{SK}} Neonatal Conjunctivitis
{{SK}} Neonatal conjunctivitis
 
==Overview==
==Overview==
'''Ophthalmia neonatorum''' known as neonatal conjunctivitis, is a form of [[conjunctivitis]] contracted by newborns during [[delivery]]. The baby's eyes are contaminated during passage through the birth canal from a mother infected with either ''[[Neisseria gonorrhoeae]]'', ''[[Chlamydia trachomatis]]'', or [[Herpes simplex virus]]. It can also be caused by bacteria, viruses, and chemical irritants (such as silver nitrate).  Thus, silver nitrate is not used very often anymore, because it can cause chemical conjunctivitis.  
'''Ophthalmia neonatorum''', or neonatal conjunctivitis, is a form of [[conjunctivitis]] that can be contracted by newborns during [[delivery]]. The baby can contract the disease if the eyes are contaminated during passage through the birth canal from a mother infected with either ''[[Neisseria gonorrhea]]'', ''[[Chlamydia trachomatis]]'', or [[Herpes simplex virus]]. It can also be caused by bacteria, viruses, and chemical irritants, such as [[silver nitrate]], which is no longer used frequently.<ref name="pmid25606121">{{cite journal| author=Mallika P, Asok T, Faisal H, Aziz S, Tan A, Intan G| title=Neonatal conjunctivitis - a review. | journal=Malays Fam Physician | year= 2008 | volume= 3 | issue= 2 | pages= 77-81 | pmid=25606121 | doi= | pmc=4170304 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25606121  }} </ref><ref name= Bacterial & Viral Conjunctivitis > Centers for Disease Control and Prevention (2016). [http://www.cdc.gov/conjunctivitis/about/diagnosis.html] Accessed on June 23, 2016</ref>
Ophthalmia neonatorum due to gonococci (''[[Neisseria gonorrhoeae]]'') typically manifests in the first 5 days of life and is associated with marked bilateral purulent discharge. In contrast, conjunctivitis secondary to infection with chlamydia (''[[Chlamydia trachomatis]]'') produces conjunctivitis after day 3 of life, but may occur up to 2 weeks after delivery. Babies infected with chlamydia may develop [[pneumonitis]] at a later stage (range 2 weeks - 19 weeks after delivery).
Ophthalmia neonatorum due to gonococci (''[[Neisseria gonorrhoeae]]'') typically manifests in the first 5 days of life and is associated with marked bilateral purulent discharge. In contrast, conjunctivitis secondary to infection with chlamydia (''[[Chlamydia trachomatis]]'') produces conjunctivitis after day 3 of life, but may occur up to 2 weeks after delivery. Babies infected with chlamydia may develop [[pneumonitis]] at a later stage (between 2 weeks and 19 weeks after delivery). Herpetic keratoconjunctivitis is a rare cause of neonatal conjunctivitis. It usually occurs within the first 2 weeks after birth. If left untreated, HSV conjunctivitis can cause corneal scarring and ulceration. Additionally, disseminated HSV infection can result in [[encephalitis]].<ref name="pmid3084664">{{cite journal| author=Fransen L, Nsanze H, Klauss V, Van der Stuyft P, D'Costa L, Brunham RC et al.| title=Ophthalmia neonatorum in Nairobi, Kenya: the roles of ''[[Neisseria gonorrhoeae]]'' and ''[[Chlamydia trachomatis]]''. | journal=J Infect Dis | year= 1986 | volume= 153 | issue= 5 | pages= 862-9 | pmid=3084664 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3084664  }} </ref><ref name=Neonatal-conjunctivitis >Centers for Disease Control and Prevention (2015)[http://www.cdc.gov/conjunctivitis/newborns.html] Accessed on June 30, 2016 </ref>
Herpetic keratoconjunctivitis is a rare cause of neonatal conjunctivitis. It usually occurs within the first 2 weeks after birth. If left untreated, HSV conjunctivitis can cause corneal scarring and ulceration. Additionally, disseminated HSV infection can result in [[encephalitis]].  


Prompt diagnosis is necessary in order to establish proper treatment and minimizing potential serious complications.
Prompt diagnosis is necessary in order to establish proper treatment and minimizing potential serious complications. Common laboratory studies for neonatal conjunctivitis may include [[Gram stain]], [[cultures]], [[Giemsa stain]], and [[polymerase chain reaction|polymerase chain reaction (PCR)]] of conjunctival scrapings.<ref name="pmid25606121">{{cite journal| author=Mallika P, Asok T, Faisal H, Aziz S, Tan A, Intan G| title=Neonatal conjunctivitis - a review. | journal=Malays Fam Physician | year= 2008 | volume= 3 | issue= 2 | pages= 77-81 | pmid=25606121 | doi= | pmc=4170304 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25606121  }} </ref><ref name="pmid26602522">{{cite journal| author=Pinto RD, Lira RP, Arieta CE, Castro RS, Bonon SH| title=The prevalence of adenoviral conjunctivitis at the Clinical Hospital of the State University of Campinas, Brazil. | journal=Clinics (Sao Paulo) | year= 2015 | volume= 70 | issue= 11 | pages= 748-50 | pmid=26602522 | doi=10.6061/clinics/2015(11)06 | pmc=4642493 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26602522  }} </ref>
Common laboratory studies for neonatal conjunctivitis may include [[Gram stain]], [[cultures]], Giemsa stain, and [[polymerase chain reaction|polymerase chain reaction (PCR)]] of conjunctival scrapings.
Effective measures for the prevention of ophthalmia neonatorum include ocular prophylaxis with 0.5% [[Erythromycin]] ointment or 1% [[Tetracycline hydrochloride]], and  
Effective measures for the prevention of ophthalmia neonatorum include ocular prophylaxis with 0.5% [[erythromycin]] ointment or 1% [[tetracycline hydrochloride]], and  
educating pregnant women on the importance of regular examinations to detect and treat [[sexually transmitted infections|sexually transmitted infections (STIs/STDs)]].
educateing pregnant women on the importance of regular examinations to detect and treat [[sexually transmitted infections|sexually transmitted infections (STD)]].
Empiric antibiotic treatment for neonatal conjunctivitis includes [[Erythromycin]] ophthalmic ointment and [[Ceftriaxone]] IV or IM. Additionally, systemic treatment is indicated in cases of [[chlamydial]] and [[HSV|Herpes simplex]] conjunctivitis to avoid systemic complications.<ref name=AmAcadofPeds>{{cite web |url=http://aapredbook.aappublications.org/ |title=Red Book - Report of the Committee on Infectious Diseases, 29th Edition. The American Academy of Pediatrics. |accessdate=2007-07-12 |format= |work=}}</ref>
Empric antibiotic treatment for neonatal conjunctivitis includes [[Erythromycin]] ophthalmic ointment and [[Ceftriaxone]] IV or IM. Additionally, systemic treatment is indicated in cases of [[chlamydial]] and herpetic conjunctivitis to avoid systemic complications.<ref>{{cite web |url=http://aapredbook.aappublications.org/ |title=Red Book - Report of the Committee on Infectious Diseases, 29th Edition. The American Academy of Pediatrics. |accessdate=2007-07-12 |format= |work=}}</ref>


==Historical Perspective==
==Historical Perspective==
*In 1750, neonatal conjunctivitis ([[ophthalmia neonatorum]]) was first described by S.T. Quellmaz.<ref name="pmid25606121">{{cite journal| author=Mallika P, Asok T, Faisal H, Aziz S, Tan A, Intan G| title=Neonatal conjunctivitis - a review. | journal=Malays Fam Physician | year= 2008 | volume= 3 | issue= 2 | pages= 77-81 | pmid=25606121 | doi= | pmc=4170304 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25606121  }} </ref>
*In 1750, neonatal conjunctivitis ([[ophthalmia neonatorum]]) was first described by S.T. Quellmaz.<ref name="pmid25606121">{{cite journal| author=Mallika P, Asok T, Faisal H, Aziz S, Tan A, Intan G| title=Neonatal conjunctivitis - a review. | journal=Malays Fam Physician | year= 2008 | volume= 3 | issue= 2 | pages= 77-81 | pmid=25606121 | doi= | pmc=4170304 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25606121  }} </ref>
*In 1881, Crédé introduced 2% silver nitrate for the first time as a prophylaxis treatment method for conjunctivitis in the [[newborns]] in Leipzig.<ref name="pmid5543850">{{cite journal| author=| title=Reports from the obstetrical clinic in Leipzig. Prevention of eye inflammation in the newborn. | journal=Am J Dis Child | year= 1971 | volume= 121 | issue= 1 | pages= 3-4 | pmid=5543850 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=5543850  }} </ref>
*In 1881, Crédé introduced 2% [[silver nitrate]] for the first time as a prophylaxis treatment method for conjunctivitis in the [[newborns]] in Leipzig.<ref name="pmid5543850">{{cite journal| author=| title=Reports from the obstetrical clinic in Leipzig. Prevention of eye inflammation in the newborn. | journal=Am J Dis Child | year= 1971 | volume= 121 | issue= 1 | pages= 3-4 | pmid=5543850 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=5543850  }} </ref>


==Classification==
==Classification==
According to the [[etiology]] ophthalmia neonatorum may be classified into:<ref name= Bacterial & Viral Conjunctivitis > Centers for Disease Control and Prevention (2016). [http://www.cdc.gov/conjunctivitis/about/diagnosis.html] Accessed on June 23, 2016</ref><ref name="pmid25606121">{{cite journal| author=Mallika P, Asok T, Faisal H, Aziz S, Tan A, Intan G| title=Neonatal conjunctivitis - a review. | journal=Malays Fam Physician | year= 2008 | volume= 3 | issue= 2 | pages= 77-81 | pmid=25606121 | doi= | pmc=4170304 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25606121  }} </ref>
Ophthalmia neonatorum may be classified according to etiology into 3 groups:<ref name="pmid25606121">{{cite journal| author=Mallika P, Asok T, Faisal H, Aziz S, Tan A, Intan G| title=Neonatal conjunctivitis - a review. | journal=Malays Fam Physician | year= 2008 | volume= 3 | issue= 2 | pages= 77-81 | pmid=25606121 | doi= | pmc=4170304 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25606121  }} </ref><ref name= Bacterial & Viral Conjunctivitis > Centers for Disease Control and Prevention (2016). [http://www.cdc.gov/conjunctivitis/about/diagnosis.html] Accessed on June 23, 2016</ref>
*[[Bacterial]]
*[[Bacterial]]
*[[Viral]]
*[[Viral]]
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==Pathophysiology==
==Pathophysiology==
===Pathogenesis===
===Pathogenesis===
Neonatal conjunctivitis is occurring in a [[newborn]] during the first month of life, and often known as [[ophthalmia neonatorum]].  
Neonatal conjunctivitis occurs in a [[newborn]] during the first month of life, and is often known as [[ophthalmia neonatorum]].  
Neonatal conjunctivitis is mainly caused by [[sexually transmitted diseases]] agents such as ''[[Chlamydia trachomatis]]'', ''[[Neisseria gonorrhoeae]]'', and [[herpes simplex virus|herpes simplex virus (HSV)]].  
Neonatal conjunctivitis is mainly caused by [[sexually transmitted disease]] agents such as ''[[Chlamydia trachomatis]]'', ''[[Neisseria gonorrhoeae]]'', and [[herpes simplex virus|herpes simplex virus (HSV)]].  
''Chlamydia trachomatis'' is the most common cause of ophthalmia neonatorum in the developed countries because of higher prevalence of chlamydia as a [[sexually transmitted disease]].
''Chlamydia trachomatis'' is the most common cause of ophthalmia neonatorum in the developed countries because of the higher prevalence of chlamydia as a [[sexually transmitted disease]].


The recognized routes of transmission of the organisms to the newborns include:<ref name="pmid7848819">{{cite journal| author=Treadwell P| title=Sexually transmitted diseases in neonates and infants. | journal=Semin Dermatol | year= 1994 | volume= 13 | issue= 4 | pages= 256-61 | pmid=7848819 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7848819  }} </ref>
The recognized routes of transmission of the organisms to the newborns include:<ref name="pmid7848819">{{cite journal| author=Treadwell P| title=Sexually transmitted diseases in neonates and infants. | journal=Semin Dermatol | year= 1994 | volume= 13 | issue= 4 | pages= 256-61 | pmid=7848819 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7848819  }} </ref>
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*Transmembrane transmission of the infection
*Transmembrane transmission of the infection
*[[Transplacental]] transmission of the infection
*[[Transplacental]] transmission of the infection
Additionally, silver nitrate drops (ocular prophylaxis) can cause ocular irritation and result in chemical conjunctivitis in newborn.<ref name="pmid25606121">{{cite journal| author=Mallika P, Asok T, Faisal H, Aziz S, Tan A, Intan G| title=Neonatal conjunctivitis - a review. | journal=Malays Fam Physician | year= 2008 | volume= 3 | issue= 2 | pages= 77-81 | pmid=25606121 | doi= | pmc=4170304 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25606121  }} </ref>
Additionally, [[silver nitrate]] drops (ocular prophylaxis) can cause ocular irritation and result in chemical conjunctivitis in newborns.<ref name="pmid25606121">{{cite journal| author=Mallika P, Asok T, Faisal H, Aziz S, Tan A, Intan G| title=Neonatal conjunctivitis - a review. | journal=Malays Fam Physician | year= 2008 | volume= 3 | issue= 2 | pages= 77-81 | pmid=25606121 | doi= | pmc=4170304 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25606121  }} </ref>
 
===Gross Pathology===
===Gross Pathology===
On [[gross pathology]], the following are characteristic findings of conjunctivitis:<ref name=AAO>American Academy of Ophthalmology Pediatric Ophthalmology/Strabismus Panel. Preferred Practice Pattern® Guidelines. Pediatric Eye Evaluations. San Francisco, CA: American Academy of Ophthalmology; 2012. Available at: www.aao.org/ppp.</ref>
On [[gross pathology]], the following are characteristic findings of conjunctivitis:<ref name=AAO>American Academy of Ophthalmology Pediatric Ophthalmology/Strabismus Panel. Preferred Practice Pattern® Guidelines. Pediatric Eye Evaluations. San Francisco, CA: American Academy of Ophthalmology; 2012. Available at: www.aao.org/ppp.</ref>
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*Pseudomembrane formation
*Pseudomembrane formation
*[[Chemosis]]
*[[Chemosis]]
*Eyelid edema
*Eyelid [[edema]]


===Microscopic histopathological analysis===
===Microscopic Histopathological Analysis===
On microscopic histopathological analysis, the following are characteristic findings of infective conjunctivitis in neonate:<ref name=Conjunctivitis > DermNet NZ (2015)[http://www.dermnetnz.org/pathology/conjunctivitis-path.html] Accessed on June 26, 2016 </ref>
On microscopic histopathological analysis, the following are characteristic findings of infective conjunctivitis in [[neonates]]:<ref name=Conjunctivitis > DermNet NZ (2015)[http://www.dermnetnz.org/pathology/conjunctivitis-path.html] Accessed on June 26, 2016 </ref>
*Mild spongiotic reaction pattern (low power view of the histology)
*Mild spongiotic reaction pattern (low power view of the histology)
*Stromal infiltration by polymorphonuclear, [[leukocytes]], [[plasma cells]], [[mastocytes]], and [[lymphocyte]]
*Stromal infiltration by polymorphonuclear, [[leukocytes]], [[plasma cells]], [[mastocytes]], and [[lymphocyte]]s
*Numerous [[neutrophils]] (bacterial conjunctivitis)
*Numerous [[neutrophils]] (bacterial conjunctivitis)
[[Image:chlamydial conjunctivitis.jpg|thumb|center|Chlamydial conjunctivitis (Day 5-14)<ref>http://picasaweb.google.com/mcmumbi/USMLEIIImages</ref>]]


==Causes==
==Causes==
Common causes of  include:<ref name="pmid25606121">{{cite journal| author=Mallika P, Asok T, Faisal H, Aziz S, Tan A, Intan G| title=Neonatal conjunctivitis - a review. | journal=Malays Fam Physician | year= 2008 | volume= 3 | issue= 2 | pages= 77-81 | pmid=25606121 | doi= | pmc=4170304 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25606121  }} </ref><ref name=Conjun-One>Woods, Charles R. "Gonococcal infections in neonates and young children." Seminars in pediatric infectious diseases. Vol. 16. No. 4. WB Saunders, 2005 </ref>
Common causes include:<ref name="pmid25606121">{{cite journal| author=Mallika P, Asok T, Faisal H, Aziz S, Tan A, Intan G| title=Neonatal conjunctivitis - a review. | journal=Malays Fam Physician | year= 2008 | volume= 3 | issue= 2 | pages= 77-81 | pmid=25606121 | doi= | pmc=4170304 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25606121  }} </ref><ref name=Conjun-One>Woods, Charles R. "Gonococcal infections in neonates and young children." Seminars in pediatric infectious diseases. Vol. 16. No. 4. WB Saunders, 2005 </ref>
*[[Bacteria]]l
*[[Bacteria]]l
**''[[Chlamydia trachomatis]]''
**''[[Chlamydia trachomatis]]''
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==Differentiating ophthalmia neonatorum from Other Diseases==
==Differentiating ophthalmia neonatorum from Other Diseases==
Neonatal conjunctivitis must be differentiated from:<ref name="pmid25606121">{{cite journal| author=Mallika P, Asok T, Faisal H, Aziz S, Tan A, Intan G| title=Neonatal conjunctivitis - a review. | journal=Malays Fam Physician | year= 2008 | volume= 3 | issue= 2 | pages= 77-81 | pmid=25606121 | doi= | pmc=4170304 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25606121  }} </ref><ref name=Conjun-One>Woods, Charles R. "Gonococcal infections in neonates and young children." Seminars in pediatric infectious diseases. Vol. 16. No. 4. WB Saunders, 2005.</ref>
Neonatal conjunctivitis must be differentiated from:<ref name="pmid25606121">{{cite journal| author=Mallika P, Asok T, Faisal H, Aziz S, Tan A, Intan G| title=Neonatal conjunctivitis - a review. | journal=Malays Fam Physician | year= 2008 | volume= 3 | issue= 2 | pages= 77-81 | pmid=25606121 | doi= | pmc=4170304 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25606121  }} </ref><ref name=Conjun-One>Woods, Charles R. "Gonococcal infections in neonates and young children." Seminars in pediatric infectious diseases. Vol. 16. No. 4. WB Saunders, 2005.</ref>
*[[Dacrocystitis]]
*Dacrocystitis
*[[glaucoma|Congenital glaucoma]]
*[[glaucoma|Congenital glaucoma]]
*Nasolacrimal duct obstruction
*Nasolacrimal duct obstruction
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==Epidemiology and Demographics==
==Epidemiology and Demographics==
===Prevalence and Incidence===
===Incidence===
*Worldwide, neonatal conjunctivitis or ophthalmia neonatorum still blinds approximately 10,000 babies annually.<ref name="pmid8771523">{{cite journal| author=Isenberg SJ, Apt L, Wood M| title=The influence of perinatal infective factors on ophthalmia neonatorum. | journal=J Pediatr Ophthalmol Strabismus | year= 1996 | volume= 33 | issue= 3 | pages= 185-8 | pmid=8771523 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8771523  }} </ref>
*Worldwide, ophthalmia neonatorum still blinds approximately 10,000 babies annually.<ref name="pmid8771523">{{cite journal| author=Isenberg SJ, Apt L, Wood M| title=The influence of perinatal infective factors on ophthalmia neonatorum. | journal=J Pediatr Ophthalmol Strabismus | year= 1996 | volume= 33 | issue= 3 | pages= 185-8 | pmid=8771523 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8771523  }} </ref>
 
===Gender===
===Gender===
*The incidence of '''neonatal conjunctivitis''' does not vary by gender.<ref name="pmid26236350">{{cite journal| author=Moore DL, MacDonald NE, Canadian Paediatric Society, Infectious Diseases and Immunization Committee| title=Preventing ophthalmia neonatorum. | journal=Can J Infect Dis Med Microbiol | year= 2015 | volume= 26 | issue= 3 | pages= 122-5 | pmid=26236350 | doi= | pmc=4507834 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26236350  }} </ref>
*The incidence of neonatal conjunctivitis does not varies by gender.<ref name="pmid26236350">{{cite journal| author=Moore DL, MacDonald NE, Canadian Paediatric Society, Infectious Diseases and Immunization Committee| title=Preventing ophthalmia neonatorum. | journal=Can J Infect Dis Med Microbiol | year= 2015 | volume= 26 | issue= 3 | pages= 122-5 | pmid=26236350 | doi= | pmc=4507834 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26236350  }} </ref>
 
===Developed Countries===
===Developed Countries===
[[Prevalence]] of '''neonatal conjunctivitis''' has decreased significantly in developed countries since the abandonment of silver nitrate as topical prophylaxis. Current prevalence of neonatal conjunctivitis in developed countries are 5 per 1000 live births.<ref name="pmid24150468">{{cite journal| author=Azari AA, Barney NP| title=Conjunctivitis: a systematic review of diagnosis and treatment. | journal=JAMA | year= 2013 | volume= 310 | issue= 16 | pages= 1721-9 | pmid=24150468 | doi=10.1001/jama.2013.280318 | pmc=4049531 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24150468  }} </ref>
The [[prevalence]] of neonatal conjunctivitis has decreased significantly in developed countries since the abandonment of [[silver nitrate]] as topical prophylaxis. Current prevalence of neonatal conjunctivitis in developed countries are 5 per 1,000 live births.<ref name="pmid24150468">{{cite journal| author=Azari AA, Barney NP| title=Conjunctivitis: a systematic review of diagnosis and treatment. | journal=JAMA | year= 2013 | volume= 310 | issue= 16 | pages= 1721-9 | pmid=24150468 | doi=10.1001/jama.2013.280318 | pmc=4049531 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24150468  }} </ref>
*In Belgium and Netherlands, the prevalence of neonatal conjunctivitis due to [[gonococcal]] infection was estimated 0.04 per 1000 live births.<ref name="pmid25606121">{{cite journal| author=Mallika P, Asok T, Faisal H, Aziz S, Tan A, Intan G| title=Neonatal conjunctivitis - a review. | journal=Malays Fam Physician | year= 2008 | volume= 3 | issue= 2 | pages= 77-81 | pmid=25606121 | doi= | pmc=4170304 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25606121  }} </ref>
*In Belgium and Netherlands, the prevalence of neonatal conjunctivitis due to [[gonococcal]] infection is estimated 0.04 per 1,000 live births.<ref name="pmid25606121">{{cite journal| author=Mallika P, Asok T, Faisal H, Aziz S, Tan A, Intan G| title=Neonatal conjunctivitis - a review. | journal=Malays Fam Physician | year= 2008 | volume= 3 | issue= 2 | pages= 77-81 | pmid=25606121 | doi= | pmc=4170304 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25606121  }} </ref>
*In the United States, the prevalence of neonatal conjunctivitis due to [[gonococcal]] infection was estiamted 0.3 per 1000 live births.
*In the United States, the prevalence of neonatal conjunctivitis due to [[gonococcal]] infection is estimated to be 0.3 per 1,000 live births.
*In the United States, the prevalence of neonatal conjunctivitis caused by [[chlamydial]] infection was estimated 5 to 60 cases per 1000 live births.
*In the United States, the prevalence of neonatal conjunctivitis caused by [[chlamydial]] infection is estimated to be between 5-60 cases per 1,000 live births.
*In the United Kingdom, the prevalence of neonatal conjunctivitis caused by [[chlamydial]] infection was estimated 4 cases per 1000 live births.<ref name="pmid11285676">{{cite journal| author=Schaller UC, Klauss V| title=Is Credé's prophylaxis for ophthalmia neonatorum still valid? | journal=Bull World Health Organ | year= 2001 | volume= 79 | issue= 3 | pages= 262-3 | pmid=11285676 | doi= | pmc=2566367 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11285676  }} </ref>
*In the United Kingdom, the prevalence of neonatal conjunctivitis caused by [[chlamydial]] infection is estimated to be 4 cases per 1,000 live births.<ref name="pmid11285676">{{cite journal| author=Schaller UC, Klauss V| title=Is Credé's prophylaxis for ophthalmia neonatorum still valid? | journal=Bull World Health Organ | year= 2001 | volume= 79 | issue= 3 | pages= 262-3 | pmid=11285676 | doi= | pmc=2566367 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11285676  }} </ref>
 
===Developing Countries===
===Developing Countries===
*In the Africa, the incidence of '''neonatal conjunctivitis''' is still high.<ref name="pmid11285676">{{cite journal| author=Schaller UC, Klauss V| title=Is Credé's prophylaxis for ophthalmia neonatorum still valid? | journal=Bull World Health Organ | year= 2001 | volume= 79 | issue= 3 | pages= 262-3 | pmid=11285676 | doi= | pmc=2566367 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11285676  }} </ref>
*In African countries, the incidence of neonatal conjunctivitis is still high.<ref name="pmid11285676">{{cite journal| author=Schaller UC, Klauss V| title=Is Credé's prophylaxis for ophthalmia neonatorum still valid? | journal=Bull World Health Organ | year= 2001 | volume= 79 | issue= 3 | pages= 262-3 | pmid=11285676 | doi= | pmc=2566367 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11285676  }} </ref>
 
==Risk Factors==
==Risk Factors==
Common risk factors in the development of neonatal conjunctivitis include:<ref name="pmid19995198">{{cite journal| author=Gichuhi S, Bosire R, Mbori-Ngacha D, Gichuhi C, Wamalwa D, Maleche-Obimbo E et al.| title=Risk factors for neonatal conjunctivitis in babies of HIV-1 infected mothers. | journal=Ophthalmic Epidemiol | year= 2009 | volume= 16 | issue= 6 | pages= 337-45 | pmid=19995198 | doi=10.3109/09286580903144746 | pmc=3223245 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19995198  }} </ref><ref name="pmid15871630">{{cite journal| author=Zar HJ| title=Neonatal chlamydial infections: prevention and treatment. | journal=Paediatr Drugs | year= 2005 | volume= 7 | issue= 2 | pages= 103-10 | pmid=15871630 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15871630  }} </ref><ref name="pmid982267">{{cite journal| author=Nahmias AJ, Visintine AM, Caldwell DR, Wilson LA| title=Eye infections with herpes simplex viruses in neonates. | journal=Surv Ophthalmol | year= 1976 | volume= 21 | issue= 2 | pages= 100-5 | pmid=982267 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=982267  }} </ref>
Common risk factors in the development of neonatal conjunctivitis include:<ref name="pmid19995198">{{cite journal| author=Gichuhi S, Bosire R, Mbori-Ngacha D, Gichuhi C, Wamalwa D, Maleche-Obimbo E et al.| title=Risk factors for neonatal conjunctivitis in babies of HIV-1 infected mothers. | journal=Ophthalmic Epidemiol | year= 2009 | volume= 16 | issue= 6 | pages= 337-45 | pmid=19995198 | doi=10.3109/09286580903144746 | pmc=3223245 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19995198  }} </ref><ref name="pmid15871630">{{cite journal| author=Zar HJ| title=Neonatal chlamydial infections: prevention and treatment. | journal=Paediatr Drugs | year= 2005 | volume= 7 | issue= 2 | pages= 103-10 | pmid=15871630 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15871630  }} </ref><ref name="pmid982267">{{cite journal| author=Nahmias AJ, Visintine AM, Caldwell DR, Wilson LA| title=Eye infections with herpes simplex viruses in neonates. | journal=Surv Ophthalmol | year= 1976 | volume= 21 | issue= 2 | pages= 100-5 | pmid=982267 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=982267  }} </ref>
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*[[Premature rupture of membranes|Premature rupture of membranes (PROM)]]                 
*[[Premature rupture of membranes|Premature rupture of membranes (PROM)]]                 
*Inadequacy of ocular prophylaxis after birth  
*Inadequacy of ocular prophylaxis after birth  
*Silver nitrate exposure             
*[[Silver nitrate]] exposure             
*Ocular trauma during delivery   
*Ocular trauma during delivery   
*[[Mechanical ventilation]]                                                 
*[[Mechanical ventilation]]                                                 
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*Poor [[prenatal care]]
*Poor [[prenatal care]]
*Poor hygienic delivery conditions
*Poor hygienic delivery conditions
==Screening==
==Screening==
[[Screening]] for ophthalmia neonatorum is not recommended. However, antibiotic ointment or eye drops is given to all babies immediately after birth to prevent conjunctivitis and other medical conditions in [[newborns]], . Occasionally, this treatment causes a mild chemical conjunctivitis, which usually clears up on its own. Screening has been recommended by CDC in pregnant women for sexually transmitted diseases (STDs) to prevent spreading the infection to the baby.<ref name= Conjunctivitis-screening > Centers for Disease Control and Prevention (2015) http://www.cdc.gov/std/tg2015/screening-recommendations.htm Accessed on June 29, 2016</ref><ref name=Screening-Chlamydia-Neisseria > Centers for Disease Control and Prevention (2002) http://www.cdc.gov/mmwr/PDF/rr/rr5115.pdf Accessed on June 29, 2016</ref>
General [[screening]] for ophthalmia neonatorum is not recommended. However, antibiotic ointment or eye drops are given to all babies immediately after birth to prevent conjunctivitis and other medical conditions in [[newborns]]. Occasionally, this treatment causes a mild chemical conjunctivitis, which usually is self-limiting. Screening for sexually transmitted diseases in pregnant women is recommended to prevent spreading the infection to the baby in order to prevent ophthalmia neonatorum.<ref name= Conjunctivitis-screening > Centers for Disease Control and Prevention (2015) http://www.cdc.gov/std/tg2015/screening-recommendations.htm Accessed on June 29, 2016</ref><ref name=Screening-Chlamydia-Neisseria > Centers for Disease Control and Prevention (2002) http://www.cdc.gov/mmwr/PDF/rr/rr5115.pdf Accessed on June 29, 2016</ref>
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==Natural History, Complications and Prognosis==
==Natural History, Complications, and Prognosis==
===Natural History===
===Natural History===
'''Neonatal conjunctivitis''' is one of the most common infections occurring in the first month of life. Chemical conjunctivitis secondary to silver nitrate solution application usually occurs in the first day of life, and disappears spontaneously within 2- 4 days. In the absence of adequate [[prophylaxis]], 30% to 42% of infants born by vaginal delivery to infected mothers will develop [[gonococcal]] conjunctivitis. Gonococcal conjunctivitis tends to occur 2-7 days after birth, and tends to be more severe than other causes of [[ophthalmia neonatorum]]. It presents with severe [[bilateral]] purulent conjunctivitis, tearing, and eyelids swelling. If left untreated, it may cause [[corneal]] involvement such as corneal [[ulceration]], diffuse opacification, and [[corneal perforation]] . This may lead to [[blindness]], ultimately [[sepsis]], or death. The onset of [[chlamydial]] conjunctivitis is usually later than gonococcal conjunctivitis. In the absence of adequate prophylaxis, 30% to 50% of infants born by vaginal delivery to infected mothers will develop chlamydial conjunctivitis. The [[incubation period]] is 5-14 days. Chlamydial conjunctivitis presents with mild [[hyperemia]], watery discharge, eyelid swelling, papillary reaction, and pseudomembrane formation. If left untreated, it can progress to copious and purulent discharge. This may lead to central corneal opacification and blindness. [[Herpetic]] conjunctivitis  is a rare cause of neonatal conjunctivitis. It usually occurs within the first 2 weeks after birth and has an incubation period of approximately 6-14 days.
Neonatal conjunctivitis is one of the most common infections occurring in the first month of life. Chemical conjunctivitis secondary to silver nitrate solution application usually occurs in the first day of life, and disappears spontaneously within 2-4 days. In the absence of adequate [[prophylaxis]], 30%-42% of infants born by vaginal delivery to infected mothers will develop [[gonococcal]] conjunctivitis. Gonococcal conjunctivitis tends to develop between 2-7 days after birth. Gonococcal conjunctivitis typically is more severe than other causes of [[ophthalmia neonatorum]] and presents with severe [[bilateral]] purulent conjunctivitis, [[tearing]], and eyelids swelling. If left untreated, it may cause [[corneal]] involvement such as corneal [[ulceration]], diffuse opacification, and [[corneal perforation]], which may to [[blindness]], [[sepsis]], or death. The onset of [[chlamydial]] conjunctivitis is usually later than gonococcal conjunctivitis. In the absence of adequate prophylaxis, 30%-50% of infants born by vaginal delivery to infected mothers will develop chlamydial conjunctivitis. The [[incubation period]] is 5-14 days. Chlamydial conjunctivitis presents with mild [[hyperemia]], watery discharge, eyelid swelling, papillary reaction, and pseudomembrane formation. If left untreated, it can progress to copious and purulent discharge. This may lead to central corneal opacification and blindness. [[Herpetic]] conjunctivitis  is a rare cause of neonatal conjunctivitis. It usually occurs within the first 2 weeks after birth and has an incubation period of approximately 6-14 days.
If left untreated, [[HSV]] conjunctivitis can cause corneal scarring and ulceration. Additionally, disseminated ''HSV'' infection can cause [[central nervous system|central nervous system (CNS)]] involvement. [[Ophthalmia neonatorum]] caused by [[pseudomonas]] is rare but can present with eyelid edema, [[erythema]], and purulent discharge. If left untreated, can progress to corneal perforation, [[endophthalmitis]], blindness, and possibly death.<ref name="pmid25606121">{{cite journal| author=Mallika P, Asok T, Faisal H, Aziz S, Tan A, Intan G| title=Neonatal conjunctivitis - a review. | journal=Malays Fam Physician | year= 2008 | volume= 3 | issue= 2 | pages= 77-81 | pmid=25606121 | doi= | pmc=4170304 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25606121  }} </ref><ref name="pmid24235191">{{cite journal| author=Matejcek A, Goldman RD| title=Treatment and prevention of ophthalmia neonatorum. | journal=Can Fam Physician | year= 2013 | volume= 59 | issue= 11 | pages= 1187-90 | pmid=24235191 | doi= | pmc=3828094 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24235191 }} </ref><ref name="pmid3084664">{{cite journal| author=Fransen L, Nsanze H, Klauss V, Van der Stuyft P, D'Costa L, Brunham RC et al.| title=Ophthalmia neonatorum in Nairobi, Kenya: the roles of ''[[Neisseria gonorrhoeae]]'' and ''[[Chlamydia trachomatis]]''. | journal=J Infect Dis | year= 1986 | volume= 153 | issue= 5 | pages= 862-9 | pmid=3084664 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3084664 }} </ref>
If left untreated, [[HSV]] conjunctivitis can cause corneal scarring and ulceration. Additionally, disseminated ''HSV'' infection can cause [[central nervous system|central nervous system (CNS)]] involvement. [[Ophthalmia neonatorum]] caused by [[pseudomonas]] is rare but can present with eyelid edema, [[erythema]], and purulent discharge. If left untreated, ophthalmia neonatorum can progress to corneal perforation, [[endophthalmitis]], blindness, and possibly death.<ref name="pmid25606121">{{cite journal| author=Mallika P, Asok T, Faisal H, Aziz S, Tan A, Intan G| title=Neonatal conjunctivitis - a review. | journal=Malays Fam Physician | year= 2008 | volume= 3 | issue= 2 | pages= 77-81 | pmid=25606121 | doi= | pmc=4170304 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25606121  }} </ref><ref name="pmid3084664">{{cite journal| author=Fransen L, Nsanze H, Klauss V, Van der Stuyft P, D'Costa L, Brunham RC et al.| title=Ophthalmia neonatorum in Nairobi, Kenya: the roles of ''[[Neisseria gonorrhoeae]]'' and ''[[Chlamydia trachomatis]]''. | journal=J Infect Dis | year= 1986 | volume= 153 | issue= 5 | pages= 862-9 | pmid=3084664 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3084664 }} </ref><ref name="pmid24235191">{{cite journal| author=Matejcek A, Goldman RD| title=Treatment and prevention of ophthalmia neonatorum. | journal=Can Fam Physician | year= 2013 | volume= 59 | issue= 11 | pages= 1187-90 | pmid=24235191 | doi= | pmc=3828094 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24235191 }} </ref>
 
===Complications===
===Complications===
Complications to neonatal conjunctivitis include:<ref name="pmid3084664">{{cite journal| author=Fransen L, Nsanze H, Klauss V, Van der Stuyft P, D'Costa L, Brunham RC et al.| title=Ophthalmia neonatorum in Nairobi, Kenya: the roles of ''[[Neisseria gonorrhoeae]]'' and ''[[Chlamydia trachomatis]]''. | journal=J Infect Dis | year= 1986 | volume= 153 | issue= 5 | pages= 862-9 | pmid=3084664 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3084664  }} </ref><ref name=Neonatal-conjunctivitis >Centers for Disease Control and Prevention (2015)[http://www.cdc.gov/conjunctivitis/newborns.html] Accessed on June 30, 2016 </ref>  
Complications to neonatal conjunctivitis include:<ref name="pmid3084664">{{cite journal| author=Fransen L, Nsanze H, Klauss V, Van der Stuyft P, D'Costa L, Brunham RC et al.| title=Ophthalmia neonatorum in Nairobi, Kenya: the roles of ''[[Neisseria gonorrhoeae]]'' and ''[[Chlamydia trachomatis]]''. | journal=J Infect Dis | year= 1986 | volume= 153 | issue= 5 | pages= 862-9 | pmid=3084664 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3084664  }} </ref><ref name=Neonatal-conjunctivitis >Centers for Disease Control and Prevention (2015)[http://www.cdc.gov/conjunctivitis/newborns.html] Accessed on June 30, 2016 </ref>  
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===Prognosis===
===Prognosis===
*Early detection and early treatment of '''neonatal conjunctivitis'''  is associated with a good prognosis.<ref name="pmid3084664">{{cite journal| author=Fransen L, Nsanze H, Klauss V, Van der Stuyft P, D'Costa L, Brunham RC et al.| title=Ophthalmia neonatorum in Nairobi, Kenya: the roles of ''[[Neisseria gonorrhoeae]]'' and ''[[Chlamydia trachomatis]]''. | journal=J Infect Dis | year= 1986 | volume= 153 | issue= 5 | pages= 862-9 | pmid=3084664 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3084664  }} </ref><ref name=Neonatal-conjunctivitis >Centers for Disease Control and Prevention (2015)[http://www.cdc.gov/conjunctivitis/newborns.html] Accessed on June 30, 2016 </ref>  
Early detection and early treatment of neonatal conjunctivitis is associated with a good prognosis.<ref name="pmid3084664">{{cite journal| author=Fransen L, Nsanze H, Klauss V, Van der Stuyft P, D'Costa L, Brunham RC et al.| title=Ophthalmia neonatorum in Nairobi, Kenya: the roles of ''[[Neisseria gonorrhoeae]]'' and ''[[Chlamydia trachomatis]]''. | journal=J Infect Dis | year= 1986 | volume= 153 | issue= 5 | pages= 862-9 | pmid=3084664 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3084664  }} </ref><ref name=Neonatal-conjunctivitis >Centers for Disease Control and Prevention (2015)[http://www.cdc.gov/conjunctivitis/newborns.html] Accessed on June 30, 2016 </ref>
 
==Diagnosis==
==Diagnosis==
Prompt diagnosis is necessary in order to establish proper treatment and minimizing potential serious complications of ophthalmia neonatorum.
Prompt diagnosis is necessary in order to establish proper treatment and minimizing potential serious complications of ophthalmia neonatorum.


===History===
===History===
A detailed and thorough history from the mother will help determine the prompt diagnosis and therapy. tSpecific areas of focus when obtaining a history from the mother include:<ref name="pmid25606121">{{cite journal| author=Mallika P, Asok T, Faisal H, Aziz S, Tan A, Intan G| title=Neonatal conjunctivitis - a review. | journal=Malays Fam Physician | year= 2008 | volume= 3 | issue= 2 | pages= 77-81 | pmid=25606121 | doi= | pmc=4170304 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25606121  }} </ref><ref name="pmid3084664">{{cite journal| author=Fransen L, Nsanze H, Klauss V, Van der Stuyft P, D'Costa L, Brunham RC et al.| title=Ophthalmia neonatorum in Nairobi, Kenya: the roles of Neisseria gonorrhoeae and Chlamydia trachomatis. | journal=J Infect Dis | year= 1986 | volume= 153 | issue= 5 | pages= 862-9 | pmid=3084664 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3084664  }} </ref><ref name=Neonatal-conjunctivitis >Centers for Disease Control and Prevention (2015)[http://www.cdc.gov/conjunctivitis/newborns.html] Accessed on June 30, 2016 </ref>
A detailed and thorough history from the mother will help determine the prompt diagnosis and therapy. Specific areas of focus when obtaining a history from the mother include:<ref name="pmid25606121">{{cite journal| author=Mallika P, Asok T, Faisal H, Aziz S, Tan A, Intan G| title=Neonatal conjunctivitis - a review. | journal=Malays Fam Physician | year= 2008 | volume= 3 | issue= 2 | pages= 77-81 | pmid=25606121 | doi= | pmc=4170304 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25606121  }} </ref><ref name="pmid3084664">{{cite journal| author=Fransen L, Nsanze H, Klauss V, Van der Stuyft P, D'Costa L, Brunham RC et al.| title=Ophthalmia neonatorum in Nairobi, Kenya: the roles of Neisseria gonorrhoeae and Chlamydia trachomatis. | journal=J Infect Dis | year= 1986 | volume= 153 | issue= 5 | pages= 862-9 | pmid=3084664 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3084664  }} </ref><ref name=Neonatal-conjunctivitis >Centers for Disease Control and Prevention (2015)[http://www.cdc.gov/conjunctivitis/newborns.html] Accessed on June 30, 2016 </ref>
*History of [[sexually transmitted disease|sexually transmitted disease (STD)]] in mother
*History of [[sexually transmitted disease|sexually transmitted disease (STD)]]
*History of ocular prophylaxis with [[silver nitrate]] at the birth
*History of ocular prophylaxis with [[silver nitrate]] at the birth
*Time frame of signs and symptoms following birth
*Time frame of signs and symptoms following birth


===Symptoms and Physical examination===
===Symptoms and Physical examination===
Symptoms of neonatal conjunctivitis ([[ophthalmia neonatorum]]), based on casualty, may include the following:<ref name="pmid25606121">{{cite journal| author=Mallika P, Asok T, Faisal H, Aziz S, Tan A, Intan G| title=Neonatal conjunctivitis - a review. | journal=Malays Fam Physician | year= 2008 | volume= 3 | issue= 2 | pages= 77-81 | pmid=25606121 | doi= | pmc=4170304 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25606121  }} </ref><ref name="pmid3084664">{{cite journal| author=Fransen L, Nsanze H, Klauss V, Van der Stuyft P, D'Costa L, Brunham RC et al.| title=Ophthalmia neonatorum in Nairobi, Kenya: the roles of Neisseria gonorrhoeae and Chlamydia trachomatis. | journal=J Infect Dis | year= 1986 | volume= 153 | issue= 5 | pages= 862-9 | pmid=3084664 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3084664  }} </ref><ref name=Neonatal-conjunctivitis >Centers for Disease Control and Prevention (2015)[http://www.cdc.gov/conjunctivitis/newborns.html] Accessed on June 30, 2016 </ref><ref name=ophthalmia-two>Rours, Ingrid GIJG, et al. "Chlamydia trachomatis as a cause of neonatal conjunctivitis in Dutch infants." Pediatrics 121.2 (2008): e321-e326.</ref><ref name=Ophthalmia-three>Pickering, Larry K. Red book®: 2003 report of the committee on infectious diseases. No. Ed. 26. American Academy of Pediatrics, 2003.</ref>
Symptoms of neonatal conjunctivitis ([[ophthalmia neonatorum]]), based on causality, may include the following:<ref name="pmid25606121">{{cite journal| author=Mallika P, Asok T, Faisal H, Aziz S, Tan A, Intan G| title=Neonatal conjunctivitis - a review. | journal=Malays Fam Physician | year= 2008 | volume= 3 | issue= 2 | pages= 77-81 | pmid=25606121 | doi= | pmc=4170304 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25606121  }} </ref><ref name="pmid3084664">{{cite journal| author=Fransen L, Nsanze H, Klauss V, Van der Stuyft P, D'Costa L, Brunham RC et al.| title=Ophthalmia neonatorum in Nairobi, Kenya: the roles of Neisseria gonorrhoeae and Chlamydia trachomatis. | journal=J Infect Dis | year= 1986 | volume= 153 | issue= 5 | pages= 862-9 | pmid=3084664 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3084664  }} </ref><ref name=Neonatal-conjunctivitis >Centers for Disease Control and Prevention (2015)[http://www.cdc.gov/conjunctivitis/newborns.html] Accessed on June 30, 2016 </ref><ref name=ophthalmia-two>Rours, Ingrid GIJG, et al. "Chlamydia trachomatis as a cause of neonatal conjunctivitis in Dutch infants." Pediatrics 121.2 (2008): e321-e326.</ref><ref name=Ophthalmia-three>Pickering, Larry K. Red book®: 2003 report of the committee on infectious diseases. No. Ed. 26. American Academy of Pediatrics, 2003.</ref>


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! style="background: #4479BA; width: 120px;" | {{fontcolor|#FFF|Causally}}
! style="background: #4479BA; width: 120px;" | {{fontcolor|#FFF|Causality}}
! style="background: #4479BA; width: 500px;" | {{fontcolor|#FFF|Symptomes}}
! style="background: #4479BA; width: 500px;" | {{fontcolor|#FFF|Symptoms}}
! style="background: #4479BA; width: 500px;" | {{fontcolor|#FFF|Physical Examination}}
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*Occurs 5-14 days after birth
*Occurs 5-14 days after birth
*Eye redness
*[[Eye redness]]
*Watery discharge
*Watery discharge
*Eyelids swelling
*Eyelids swelling
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*Watery discharge
*Watery discharge
*Skin lesions on the lid margins
*Skin lesions on the lid margins
*Eye redness
*[[Eye redness]]
*Lid edema
*Eyelid edema
| style="padding: 5px 5px; background: #F5F5F5;" |  
| style="padding: 5px 5px; background: #F5F5F5;" |  
*Nonspecific lid edema
*Nonspecific lid edema
*Non Mucopurulent discharge
*Non-mucopurulent discharge
*[[Hyperemia]]
*[[Hyperemia]]
*Vesicular lesions on the skin or lid margins
*Vesicular lesions on the skin or lid margins
Line 228: Line 233:
|}
|}


==Diagnosis==
===Laboratory Findings===
Prompt diagnosis is necessary in order to establish proper treatment and minimizing potential serious complications of ophthalmia neonatorum
Common laboratory studies for neonatal conjunctivitis may include the following:<ref name="pmid25606121">{{cite journal| author=Mallika P, Asok T, Faisal H, Aziz S, Tan A, Intan G| title=Neonatal conjunctivitis - a review. | journal=Malays Fam Physician | year= 2008 | volume= 3 | issue= 2 | pages= 77-81 | pmid=25606121 | doi= | pmc=4170304 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25606121  }} </ref><ref name="pmid26602522">{{cite journal| author=Pinto RD, Lira RP, Arieta CE, Castro RS, Bonon SH| title=The prevalence of adenoviral conjunctivitis at the Clinical Hospital of the State University of Campinas, Brazil. | journal=Clinics (Sao Paulo) | year= 2015 | volume= 70 | issue= 11 | pages= 748-50 | pmid=26602522 | doi=10.6061/clinics/2015(11)06 | pmc=4642493 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26602522 }} </ref><ref name="pmid26077630">{{cite journal| author=Jhanji V, Chan TC, Li EY, Agarwal K, Vajpayee RB| title=Adenoviral keratoconjunctivitis. | journal=Surv Ophthalmol | year= 2015 | volume= 60 | issue= 5 | pages= 435-43 | pmid=26077630 | doi=10.1016/j.survophthal.2015.04.001 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26077630 }} </ref><ref name="pmid15195156">{{cite journal| author=Høvding G| title=[Acute bacterial conjunctivitis]. | journal=Tidsskr Nor Laegeforen | year= 2004 | volume= 124 | issue= 11 | pages= 1518-20 | pmid=15195156 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15195156 }} </ref><ref name="pmid17970823">{{cite journal| author=Høvding G| title=Acute bacterial conjunctivitis. | journal=Acta Ophthalmol | year= 2008 | volume= 86 | issue= 1 | pages= 5-17 | pmid=17970823 | doi=10.1111/j.1600-0420.2007.01006.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17970823  }} </ref><ref name=Ophthalmia-three>Pickering, Larry K. Red book®: 2003 report of the committee on infectious diseases. No. Ed. 26. American Academy of Pediatrics, 2003.</ref>
===History===
A detailed and thorough history will help determine the prompt diagnosis and treatment. It includes:<ref name="pmid25606121">{{cite journal| author=Mallika P, Asok T, Faisal H, Aziz S, Tan A, Intan G| title=Neonatal conjunctivitis - a review. | journal=Malays Fam Physician | year= 2008 | volume= 3 | issue= 2 | pages= 77-81 | pmid=25606121 | doi= | pmc=4170304 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25606121  }} </ref><ref name="pmid3084664">{{cite journal| author=Fransen L, Nsanze H, Klauss V, Van der Stuyft P, D'Costa L, Brunham RC et al.| title=Ophthalmia neonatorum in Nairobi, Kenya: the roles of Neisseria gonorrhoeae and Chlamydia trachomatis. | journal=J Infect Dis | year= 1986 | volume= 153 | issue= 5 | pages= 862-9 | pmid=3084664 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3084664 }} </ref><ref name=Neonatal-conjunctivitis >Centers for Disease Control and Prevention (2015)[http://www.cdc.gov/conjunctivitis/newborns.html] Accessed on June 30, 2016 </ref>
*History of [[sexually transmitted disease|sexually transmitted disease (STD)]] in mother
*History of ocular prophylaxis with silver nitrate
*Correct time frame of signs/symptoms from the mother
 
===Symptoms & Physical examination===
Symptoms of neonatal conjunctivitis ([[ophthalmia neonatorum]]), based on casualty, may include the following:<ref name="pmid25606121">{{cite journal| author=Mallika P, Asok T, Faisal H, Aziz S, Tan A, Intan G| title=Neonatal conjunctivitis - a review. | journal=Malays Fam Physician | year= 2008 | volume= 3 | issue= 2 | pages= 77-81 | pmid=25606121 | doi= | pmc=4170304 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25606121 }} </ref><ref name="pmid3084664">{{cite journal| author=Fransen L, Nsanze H, Klauss V, Van der Stuyft P, D'Costa L, Brunham RC et al.| title=Ophthalmia neonatorum in Nairobi, Kenya: the roles of Neisseria gonorrhoeae and Chlamydia trachomatis. | journal=J Infect Dis | year= 1986 | volume= 153 | issue= 5 | pages= 862-9 | pmid=3084664 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3084664 }} </ref><ref name=Neonatal-conjunctivitis >Centers for Disease Control and Prevention (2015)[http://www.cdc.gov/conjunctivitis/newborns.html] Accessed on June 30, 2016 </ref><ref name=ophthalmia-two>Rours, Ingrid GIJG, et al. "Chlamydia trachomatis as a cause of neonatal conjunctivitis in Dutch infants." Pediatrics 121.2 (2008): e321-e326.</ref><ref name=Ophthalmia-three>Pickering, Larry K. Red book®: 2003 report of the committee on infectious diseases. No. Ed. 26. American Academy of Pediatrics, 2003.</ref>
 
{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
|+
! style="background: #4479BA; width: 120px;" | {{fontcolor|#FFF|Causality}}
! style="background: #4479BA; width: 500px;" | {{fontcolor|#FFF|Symptomes}}
! style="background: #4479BA; width: 500px;" | {{fontcolor|#FFF|Physical Examination}}
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''''[[Gonococcal]]'''''
| style="padding: 5px 5px; background: #F5F5F5;" |
*Occurs within 2-5 days after birth
*Severe white bilateral discharge
*Tearing
*Eyelids swellings
| style="padding: 5px 5px; background: #F5F5F5;" |
*[[Chemosis]]
*Severe lid edema
*[[Mucopurulent discharge]]
*[[Corneal]] involvement
**Diffuse epithelial edema, [[ulceration]], corneal perforation, and [[endophthalmitis]]
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''''[[Chlamydial]]'''''
| style="padding: 5px 5px; background: #F5F5F5;" |
*Occurs 5-14 days after birth
*Eye redness
*Watery discharge
*Eyelids swelling
| style="padding: 5px 5px; background: #F5F5F5;" |
*Mild [[hyperemia]]
*Mucoid discharge
*[[Chemosis]]
*Pseudomembrane formation
*Peripheral pannus
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Herpes simplex virus|Herpetic]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |
*Occurs within 2 weeks after birth
*Occurs following [[Herpes simplex virus|HSV]] systemic or CNS infection
*Watery discharge
*Skin lesions on the lid margins
*Eye redness
*Lid edema
| style="padding: 5px 5px; background: #F5F5F5;" |
*Nonspecific lid edema
*Non Mucopurulent discharge
*[[Hyperemia]]
*Vesicular lesions on the skin or lid margins
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''''Chemical'''''
| style="padding: 5px 5px; background: #F5F5F5;" |
*Occurs within 24 hours of instillation of silver nitrate solution
*Resolves spontaneously within a few days
*Eyelids swelling
*Eye redness
*Tearing
| style="padding: 5px 5px; background: #F5F5F5;" |
*Mild conjunctival injection
*[[Epiphora]]
|}


===Laboratory findings===
*[[Gram stain]]
Common laboratory studies for neonatal conjunctivitis may include the following:<ref name="pmid25606121">{{cite journal| author=Mallika P, Asok T, Faisal H, Aziz S, Tan A, Intan G| title=Neonatal conjunctivitis - a review. | journal=Malays Fam Physician | year= 2008 | volume= 3 | issue= 2 | pages= 77-81 | pmid=25606121 | doi= | pmc=4170304 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25606121  }} </ref><ref name="pmid26602522">{{cite journal| author=Pinto RD, Lira RP, Arieta CE, Castro RS, Bonon SH| title=The prevalence of adenoviral conjunctivitis at the Clinical Hospital of the State University of Campinas, Brazil. | journal=Clinics (Sao Paulo) | year= 2015 | volume= 70 | issue= 11 | pages= 748-50 | pmid=26602522 | doi=10.6061/clinics/2015(11)06 | pmc=4642493 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26602522  }} </ref><ref name="pmid26077630">{{cite journal| author=Jhanji V, Chan TC, Li EY, Agarwal K, Vajpayee RB| title=Adenoviral keratoconjunctivitis. | journal=Surv Ophthalmol | year= 2015 | volume= 60 | issue= 5 | pages= 435-43 | pmid=26077630 | doi=10.1016/j.survophthal.2015.04.001 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26077630  }} </ref><ref name="pmid15195156">{{cite journal| author=Høvding G| title=[Acute bacterial conjunctivitis]. | journal=Tidsskr Nor Laegeforen | year= 2004 | volume= 124 | issue= 11 | pages= 1518-20 | pmid=15195156 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15195156  }} </ref><ref name="pmid17970823">{{cite journal| author=Høvding G| title=Acute bacterial conjunctivitis. | journal=Acta Ophthalmol | year= 2008 | volume= 86 | issue= 1 | pages= 5-17 | pmid=17970823 | doi=10.1111/j.1600-0420.2007.01006.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17970823  }} </ref><ref name=Ped-conjun>Pickering, Larry K. Red book®: 2003 report of the committee on infectious diseases. No. Ed. 26. American Academy of Pediatrics, 2003.</ref>
*Cultures ([[blood agar]], [[chocolate agar]], or [[Thayer-Martin]])
*Conjunctival scrapings
*[[Giemsa stain]]
**Gram stain
*[[polymerase chain reaction|Polymerase chain reaction (PCR)]]
**Cultures (blood agar, [[chocolate agar]] or Thayer-Martin)
**Giemsa stain
**[[polymerase chain reaction|Polymerase chain reaction (PCR)]]


====Chlamydial====
====Chlamydial====
Line 311: Line 247:
*[[polymerase chain reaction|Polymerase chain reaction (PCR)]] of conjunctival scrapings
*[[polymerase chain reaction|Polymerase chain reaction (PCR)]] of conjunctival scrapings
*[[DNA hybridization]] assays  
*[[DNA hybridization]] assays  
*Enzyme immuno-assays for chlamydia organisms
*Enzyme [[immunoassays]] for chlamydia organisms


====Gonococcal====
====Gonococcal====
*[[Gram staining]] of conjunctival scrapings for ([[Gram-negative]] intra-cellular [[diplococci]] and [[neutrophils]])
*[[Gram staining]] of conjunctival scrapings for ([[Gram-negative]] intra-cellular [[diplococci]] and [[neutrophils]])
*[[Chocolate agar]] or Thayer-Martincultures for [[Neisseria|Neisseria species]]
*[[Chocolate agar]] or Thayer-Martin cultures for [[Neisseria|Neisseria species]]


====Viral====
====Viral====
Line 321: Line 257:
*Direct florescent antibody (rapid detection)
*Direct florescent antibody (rapid detection)
*Conjunctival scrapings for [[polymerase chain reaction|polymerase chain reaction (PCR)]] (more sensitive than viral culture)
*Conjunctival scrapings for [[polymerase chain reaction|polymerase chain reaction (PCR)]] (more sensitive than viral culture)
===Imaging Findings===
===Imaging Findings===
There are no imaging findings associated with neonatal conjunctivitis. However, CT scan and MRI may be helpful in the diagnosis of other related complication such as [[orbital cellulitis]], [[meningitis]], [[encephalitis]], and [[pneumonia]].<ref name="pmid24696045">{{cite journal| author=Qazi Y, Aggarwal S, Hamrah P| title=Image-guided evaluation and monitoring of treatment response in patients with dry eye disease. | journal=Graefes Arch Clin Exp Ophthalmol | year= 2014 | volume= 252 | issue= 6 | pages= 857-72 | pmid=24696045 | doi=10.1007/s00417-014-2618-2 | pmc=4038672 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24696045  }} </ref>
There are no imaging findings associated with neonatal conjunctivitis. However, CT scan and MRI may be helpful in the diagnosis of other related complication such as [[orbital cellulitis]], [[meningitis]], [[encephalitis]], and [[pneumonia]].


==Treatment==
==Treatment==
===Medical Treatment===
===Medical Treatment===
*Empric antibiotic treatment for neonatal conjunctivitis includes [[Erythromycin]] ophthalmic ointment and [[Ceftriaxone]] IV or IM, the treatment is altered when culture results are available
*Empiric antibiotic treatment for neonatal conjunctivitis includes [[Erythromycin]] ophthalmic ointment and [[Ceftriaxone]] IV or IM - the treatment is altered when culture results are available
*Systemic treatment is necessary in cases of [[chlamydial]] conjunctivitis to eradicate the bacteria in the [[nasopharynx]]
*Systemic treatment is necessary in cases of [[chlamydial]] conjunctivitis to eradicate the bacteria in the [[nasopharynx]]
*Prompt treatment of gonococcal conjunctivitis is essential in order to prevent the corneal ulceration
*Prompt treatment of [[gonococcal]] conjunctivitis is essential in order to prevent the corneal ulceration
*Systemic [[acyclovir]] is necessary in a case of HSV conjunctivitis to reduce the risk of a systemic infection
*Systemic [[Acyclovir]] is necessary in a case of [[HSV]] conjunctivitis to reduce the risk of a systemic infection
*Neonates with HSV infection require prompt consultation with the pediatrician, because systemic HSV infection can result in life-threatening condition
*Neonates with HSV infection require prompt consultation with the pediatrician, because systemic HSV infection can result in life-threatening condition


Line 356: Line 293:
::::*Note (2): Corticosteroids should be avoided
::::*Note (2): Corticosteroids should be avoided
'''Chemical conjunctivitis'''
'''Chemical conjunctivitis'''
*Treatment of neonatal chemical conjunctivitis is not required
*Treatment of neonatal chemical conjunctivitis is not require
**Disappears spontaneously with 2 to 3 days


===Surgery===
===Surgery===
Surgical intervention is not recommended for the management of neonatal conjunctivitis ([[ophthalmia neonatorum]]).<ref name="pmid25606121">{{cite journal| author=Mallika P, Asok T, Faisal H, Aziz S, Tan A, Intan G| title=Neonatal conjunctivitis - a review. | journal=Malays Fam Physician | year= 2008 | volume= 3 | issue= 2 | pages= 77-81 | pmid=25606121 | doi= | pmc=4170304 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25606121  }} </ref>
Surgical intervention is not recommended for the management of neonatal conjunctivitis ([[ophthalmia neonatorum]]).<ref name="pmid25606121">{{cite journal| author=Mallika P, Asok T, Faisal H, Aziz S, Tan A, Intan G| title=Neonatal conjunctivitis - a review. | journal=Malays Fam Physician | year= 2008 | volume= 3 | issue= 2 | pages= 77-81 | pmid=25606121 | doi= | pmc=4170304 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25606121  }} </ref>
===Primary Prevention===
===Primary Prevention===
Effective measures for the primary prevention of ophthalmia neonatorum include:<ref name="pmid24235191">{{cite journal| author=Matejcek A, Goldman RD| title=Treatment and prevention of ophthalmia neonatorum. | journal=Can Fam Physician | year= 2013 | volume= 59 | issue= 11 | pages= 1187-90 | pmid=24235191 | doi= | pmc=3828094 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24235191  }} </ref>
Effective measures for the primary prevention of ophthalmia neonatorum include:<ref name="pmid24235191">{{cite journal| author=Matejcek A, Goldman RD| title=Treatment and prevention of ophthalmia neonatorum. | journal=Can Fam Physician | year= 2013 | volume= 59 | issue= 11 | pages= 1187-90 | pmid=24235191 | doi= | pmc=3828094 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24235191  }} </ref>
Line 366: Line 305:
**Systemic prophylaxis with [[ceftriaxone]] 50 mg/kg IM or IV, single dose is recommended in the neonate born to mothers with untreated or suspected [[gonococcal]] infection
**Systemic prophylaxis with [[ceftriaxone]] 50 mg/kg IM or IV, single dose is recommended in the neonate born to mothers with untreated or suspected [[gonococcal]] infection
*Educate pregnant women on the importance of regular examinations to detect and treat [[sexually transmitted infections|sexually transmitted infections (STD)]]
*Educate pregnant women on the importance of regular examinations to detect and treat [[sexually transmitted infections|sexually transmitted infections (STD)]]
*Avoid vaginal delivery ([[HSV]] Transmission rates are high for women who acquire [[genital herpes]] in the last few weeks of pregnancy)
*Avoid vaginal delivery ([[HSV]] transmission rates are high for women who acquire [[genital herpes]] in the last few weeks of pregnancy)
*Avoid ocular [[prophylaxis]] with silver nitrate
*Avoid ocular [[prophylaxis]] with silver nitrate


Line 376: Line 315:
==References==
==References==
{{reflist|2}}
{{reflist|2}}
{{WS}}
{{WH}}


[[Category:Ophthalmology]]
[[Category:Ophthalmology]]
[[Category:Infectious disease]]
[[Category:Primary care]]
[[Category:Pediatrics]]
[[Category:Pediatrics]]
 
[[Category:FinalQCRequired]]
 
[[Category:Emergency medicine]]
 
[[Category:Disease]]
{{WS}}
[[Category:Up-To-Date]]
{{WH}}

Latest revision as of 23:00, 29 July 2020

Source: https://www.cdc.gov/

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [3]; Associate Editor(s)-in-Chief: Sara Mehrsefat, M.D. [4]

Synonyms and keywords: Neonatal conjunctivitis

Overview

Ophthalmia neonatorum, or neonatal conjunctivitis, is a form of conjunctivitis that can be contracted by newborns during delivery. The baby can contract the disease if the eyes are contaminated during passage through the birth canal from a mother infected with either Neisseria gonorrhea, Chlamydia trachomatis, or Herpes simplex virus. It can also be caused by bacteria, viruses, and chemical irritants, such as silver nitrate, which is no longer used frequently.[1] Ophthalmia neonatorum due to gonococci (Neisseria gonorrhoeae) typically manifests in the first 5 days of life and is associated with marked bilateral purulent discharge. In contrast, conjunctivitis secondary to infection with chlamydia (Chlamydia trachomatis) produces conjunctivitis after day 3 of life, but may occur up to 2 weeks after delivery. Babies infected with chlamydia may develop pneumonitis at a later stage (between 2 weeks and 19 weeks after delivery). Herpetic keratoconjunctivitis is a rare cause of neonatal conjunctivitis. It usually occurs within the first 2 weeks after birth. If left untreated, HSV conjunctivitis can cause corneal scarring and ulceration. Additionally, disseminated HSV infection can result in encephalitis.[2][3]

Prompt diagnosis is necessary in order to establish proper treatment and minimizing potential serious complications. Common laboratory studies for neonatal conjunctivitis may include Gram stain, cultures, Giemsa stain, and polymerase chain reaction (PCR) of conjunctival scrapings.[1][4] Effective measures for the prevention of ophthalmia neonatorum include ocular prophylaxis with 0.5% Erythromycin ointment or 1% Tetracycline hydrochloride, and educating pregnant women on the importance of regular examinations to detect and treat sexually transmitted infections (STIs/STDs). Empiric antibiotic treatment for neonatal conjunctivitis includes Erythromycin ophthalmic ointment and Ceftriaxone IV or IM. Additionally, systemic treatment is indicated in cases of chlamydial and Herpes simplex conjunctivitis to avoid systemic complications.[5]

Historical Perspective

  • In 1750, neonatal conjunctivitis (ophthalmia neonatorum) was first described by S.T. Quellmaz.[1]
  • In 1881, Crédé introduced 2% silver nitrate for the first time as a prophylaxis treatment method for conjunctivitis in the newborns in Leipzig.[6]

Classification

Ophthalmia neonatorum may be classified according to etiology into 3 groups:[1]

Pathophysiology

Pathogenesis

Neonatal conjunctivitis occurs in a newborn during the first month of life, and is often known as ophthalmia neonatorum. Neonatal conjunctivitis is mainly caused by sexually transmitted disease agents such as Chlamydia trachomatis, Neisseria gonorrhoeae, and herpes simplex virus (HSV). Chlamydia trachomatis is the most common cause of ophthalmia neonatorum in the developed countries because of the higher prevalence of chlamydia as a sexually transmitted disease.

The recognized routes of transmission of the organisms to the newborns include:[7]

  • Infected birth canal during vaginal birth
  • Transmembrane transmission of the infection
  • Transplacental transmission of the infection

Additionally, silver nitrate drops (ocular prophylaxis) can cause ocular irritation and result in chemical conjunctivitis in newborns.[1]

Gross Pathology

On gross pathology, the following are characteristic findings of conjunctivitis:[8]

Microscopic Histopathological Analysis

On microscopic histopathological analysis, the following are characteristic findings of infective conjunctivitis in neonates:[9]

Causes

Common causes include:[1][10]

Differentiating ophthalmia neonatorum from Other Diseases

Neonatal conjunctivitis must be differentiated from:[1][10]

Epidemiology and Demographics

Incidence

  • Worldwide, ophthalmia neonatorum still blinds approximately 10,000 babies annually.[11]

Gender

  • The incidence of neonatal conjunctivitis does not varies by gender.[12]

Developed Countries

The prevalence of neonatal conjunctivitis has decreased significantly in developed countries since the abandonment of silver nitrate as topical prophylaxis. Current prevalence of neonatal conjunctivitis in developed countries are 5 per 1,000 live births.[13]

  • In Belgium and Netherlands, the prevalence of neonatal conjunctivitis due to gonococcal infection is estimated 0.04 per 1,000 live births.[1]
  • In the United States, the prevalence of neonatal conjunctivitis due to gonococcal infection is estimated to be 0.3 per 1,000 live births.
  • In the United States, the prevalence of neonatal conjunctivitis caused by chlamydial infection is estimated to be between 5-60 cases per 1,000 live births.
  • In the United Kingdom, the prevalence of neonatal conjunctivitis caused by chlamydial infection is estimated to be 4 cases per 1,000 live births.[14]

Developing Countries

  • In African countries, the incidence of neonatal conjunctivitis is still high.[14]

Risk Factors

Common risk factors in the development of neonatal conjunctivitis include:[15][16][17]

Screening

General screening for ophthalmia neonatorum is not recommended. However, antibiotic ointment or eye drops are given to all babies immediately after birth to prevent conjunctivitis and other medical conditions in newborns. Occasionally, this treatment causes a mild chemical conjunctivitis, which usually is self-limiting. Screening for sexually transmitted diseases in pregnant women is recommended to prevent spreading the infection to the baby in order to prevent ophthalmia neonatorum.[18][19]

Organism Screening Recommendations in Pregnant Women
Chlamydia
  • All pregnant women under 25 years of age
  • Pregnant women, aged 25 and older if at increased risk
  • Retest during the 3rd trimester for women under 25 years of age or at risk
  • Pregnant women with chlamydial infection should have a test-of-cure 3-4 weeks after treatment and be retested within 3 months
Gonorrhea
  • All pregnant women under 25 years of age and older women if at increased risk
  • Retest 3 months after treatment
Herpes simplex virus
  • Evidence does not support routine HSV-2 serologic screening among asymptomatic pregnant women
  • Type-specific serologic tests might be useful for identifying pregnant women at risk for HSV infection

Natural History, Complications, and Prognosis

Natural History

Neonatal conjunctivitis is one of the most common infections occurring in the first month of life. Chemical conjunctivitis secondary to silver nitrate solution application usually occurs in the first day of life, and disappears spontaneously within 2-4 days. In the absence of adequate prophylaxis, 30%-42% of infants born by vaginal delivery to infected mothers will develop gonococcal conjunctivitis. Gonococcal conjunctivitis tends to develop between 2-7 days after birth. Gonococcal conjunctivitis typically is more severe than other causes of ophthalmia neonatorum and presents with severe bilateral purulent conjunctivitis, tearing, and eyelids swelling. If left untreated, it may cause corneal involvement such as corneal ulceration, diffuse opacification, and corneal perforation, which may to blindness, sepsis, or death. The onset of chlamydial conjunctivitis is usually later than gonococcal conjunctivitis. In the absence of adequate prophylaxis, 30%-50% of infants born by vaginal delivery to infected mothers will develop chlamydial conjunctivitis. The incubation period is 5-14 days. Chlamydial conjunctivitis presents with mild hyperemia, watery discharge, eyelid swelling, papillary reaction, and pseudomembrane formation. If left untreated, it can progress to copious and purulent discharge. This may lead to central corneal opacification and blindness. Herpetic conjunctivitis is a rare cause of neonatal conjunctivitis. It usually occurs within the first 2 weeks after birth and has an incubation period of approximately 6-14 days. If left untreated, HSV conjunctivitis can cause corneal scarring and ulceration. Additionally, disseminated HSV infection can cause central nervous system (CNS) involvement. Ophthalmia neonatorum caused by pseudomonas is rare but can present with eyelid edema, erythema, and purulent discharge. If left untreated, ophthalmia neonatorum can progress to corneal perforation, endophthalmitis, blindness, and possibly death.[1][2][20]

Complications

Complications to neonatal conjunctivitis include:[2][3]

Prognosis

Early detection and early treatment of neonatal conjunctivitis is associated with a good prognosis.[2][3]

Diagnosis

Prompt diagnosis is necessary in order to establish proper treatment and minimizing potential serious complications of ophthalmia neonatorum.

History

A detailed and thorough history from the mother will help determine the prompt diagnosis and therapy. Specific areas of focus when obtaining a history from the mother include:[1][2][3]

Symptoms and Physical examination

Symptoms of neonatal conjunctivitis (ophthalmia neonatorum), based on causality, may include the following:[1][2][3][21][22]

Causality Symptoms Physical Examination
Gonococcal
  • Occurs within 2-5 days after birth
  • Severe white bilateral discharge
  • Tearing
  • Eyelids swellings
Chlamydial
  • Occurs 5-14 days after birth
  • Eye redness
  • Watery discharge
  • Eyelids swelling
Herpetic
  • Occurs within 2 weeks after birth
  • Occurs following systemic and CNS infection
  • Watery discharge
  • Skin lesions on the lid margins
  • Eye redness
  • Eyelid edema
  • Nonspecific lid edema
  • Non-mucopurulent discharge
  • Hyperemia
  • Vesicular lesions on the skin or lid margins
Chemical
  • Occurs within 24 hours of instillation of silver nitrate solution
  • Resolves spontaneously within a few days
  • Eyelids swelling
  • Eye redness
  • Tearing

Laboratory Findings

Common laboratory studies for neonatal conjunctivitis may include the following:[1][4][23][24][25][22]

Chlamydial

Gonococcal

Viral

  • Viral culture of corneal epithelial cells for HSV
  • Direct florescent antibody (rapid detection)
  • Conjunctival scrapings for polymerase chain reaction (PCR) (more sensitive than viral culture)

Imaging Findings

There are no imaging findings associated with neonatal conjunctivitis. However, CT scan and MRI may be helpful in the diagnosis of other related complication such as orbital cellulitis, meningitis, encephalitis, and pneumonia.

Treatment

Medical Treatment

  • Empiric antibiotic treatment for neonatal conjunctivitis includes Erythromycin ophthalmic ointment and Ceftriaxone IV or IM - the treatment is altered when culture results are available
  • Systemic treatment is necessary in cases of chlamydial conjunctivitis to eradicate the bacteria in the nasopharynx
  • Prompt treatment of gonococcal conjunctivitis is essential in order to prevent the corneal ulceration
  • Systemic Acyclovir is necessary in a case of HSV conjunctivitis to reduce the risk of a systemic infection
  • Neonates with HSV infection require prompt consultation with the pediatrician, because systemic HSV infection can result in life-threatening condition

Infectious conjunctivitis[26][27]

  • 1. Common causative pathogens
  • 2. Conjunctivitis, neonatal prophylaxis
  • Preferred regimen (1): 0.5% Erythromycin ophthalmic ointment, single dose
  • Alternative regimen: 2.5% Providone-iodine solution ophthalmic ointment, single dose
  • 3. Empiric antimicrobial therapy
  • Preferred regimen (1): 0.5% Erythromycin ophthalmic ointment and Ceftriaxone 25-50 mg/kg (maximum dose 125 mg) IV or IM single dose
  • 4. Pathogen-directed antimicrobial therapy
  • 4.1 Chlamydia trachomatis
  • Neonatal regimen: Erythromycin 50 mg/kg/day PO qid for 2 weeks OR Ethylsuccinate 50 mg/kg/day PO qid for 2 weeks
  • Note (1): Neonates administered Erythromycin should be followed for signs and symptoms of infantile hypertrophic pyloric stenosis
  • 4.2 Neisseria gonorrhoeae
  • Neonatal dose: Ceftriaxone 25-50 mg/kg (maximum dose 125 mg) IV or IM, single dose
  • 4.3 Herpes Simplex Virus
  • Preferred regimen: Acyclovir 60 mg/kg IV tid for 2 weeks
  • Alternative regimen (1): Trifluridine 1% solution q4h for 1 week
  • Alternative regimen (2): Acyclovir 200 mg to 400 mg PO q5h per day for 1 week
  • Alternative regimen (5): Ganciclovir 0.15% ophthlamic gel qid for 1 week
  • Note (1): Prompt consultation with the pediatrician because systemic HSV infection is a life-threatening condition
  • Note (2): Corticosteroids should be avoided

Chemical conjunctivitis

  • Treatment of neonatal chemical conjunctivitis is not require
    • Disappears spontaneously with 2 to 3 days

Surgery

Surgical intervention is not recommended for the management of neonatal conjunctivitis (ophthalmia neonatorum).[1]

Primary Prevention

Effective measures for the primary prevention of ophthalmia neonatorum include:[20]

Secondary Prevention

Effective measures for the secondary prevention of ophthalmia neonatorum include:[20][28]

  • Prompt diagnosis
  • Initiate appropriate and aggressive treatment

References

  1. ↑ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 1.12 Mallika P, Asok T, Faisal H, Aziz S, Tan A, Intan G (2008). "Neonatal conjunctivitis - a review". Malays Fam Physician. 3 (2): 77–81. PMC 4170304. PMID 25606121.
  2. ↑ 2.0 2.1 2.2 2.3 2.4 2.5 Fransen L, Nsanze H, Klauss V, Van der Stuyft P, D'Costa L, Brunham RC; et al. (1986). "Ophthalmia neonatorum in Nairobi, Kenya: the roles of [[Neisseria gonorrhoeae]] and [[Chlamydia trachomatis]]". J Infect Dis. 153 (5): 862–9. PMID 3084664. URL–wikilink conflict (help)
  3. ↑ 3.0 3.1 3.2 3.3 3.4 Centers for Disease Control and Prevention (2015)[1] Accessed on June 30, 2016
  4. ↑ 4.0 4.1 Pinto RD, Lira RP, Arieta CE, Castro RS, Bonon SH (2015). "The prevalence of adenoviral conjunctivitis at the Clinical Hospital of the State University of Campinas, Brazil". Clinics (Sao Paulo). 70 (11): 748–50. doi:10.6061/clinics/2015(11)06. PMC 4642493. PMID 26602522.
  5. ↑ "Red Book - Report of the Committee on Infectious Diseases, 29th Edition. The American Academy of Pediatrics". Retrieved 2007-07-12.
  6. ↑ "Reports from the obstetrical clinic in Leipzig. Prevention of eye inflammation in the newborn". Am J Dis Child. 121 (1): 3–4. 1971. PMID 5543850.
  7. ↑ Treadwell P (1994). "Sexually transmitted diseases in neonates and infants". Semin Dermatol. 13 (4): 256–61. PMID 7848819.
  8. ↑ American Academy of Ophthalmology Pediatric Ophthalmology/Strabismus Panel. Preferred Practice Pattern® Guidelines. Pediatric Eye Evaluations. San Francisco, CA: American Academy of Ophthalmology; 2012. Available at: www.aao.org/ppp.
  9. ↑ DermNet NZ (2015)[2] Accessed on June 26, 2016
  10. ↑ 10.0 10.1 Woods, Charles R. "Gonococcal infections in neonates and young children." Seminars in pediatric infectious diseases. Vol. 16. No. 4. WB Saunders, 2005
  11. ↑ Isenberg SJ, Apt L, Wood M (1996). "The influence of perinatal infective factors on ophthalmia neonatorum". J Pediatr Ophthalmol Strabismus. 33 (3): 185–8. PMID 8771523.
  12. ↑ Moore DL, MacDonald NE, Canadian Paediatric Society, Infectious Diseases and Immunization Committee (2015). "Preventing ophthalmia neonatorum". Can J Infect Dis Med Microbiol. 26 (3): 122–5. PMC 4507834. PMID 26236350.
  13. ↑ Azari AA, Barney NP (2013). "Conjunctivitis: a systematic review of diagnosis and treatment". JAMA. 310 (16): 1721–9. doi:10.1001/jama.2013.280318. PMC 4049531. PMID 24150468.
  14. ↑ 14.0 14.1 Schaller UC, Klauss V (2001). "Is Credé's prophylaxis for ophthalmia neonatorum still valid?". Bull World Health Organ. 79 (3): 262–3. PMC 2566367. PMID 11285676.
  15. ↑ Gichuhi S, Bosire R, Mbori-Ngacha D, Gichuhi C, Wamalwa D, Maleche-Obimbo E; et al. (2009). "Risk factors for neonatal conjunctivitis in babies of HIV-1 infected mothers". Ophthalmic Epidemiol. 16 (6): 337–45. doi:10.3109/09286580903144746. PMC 3223245. PMID 19995198.
  16. ↑ Zar HJ (2005). "Neonatal chlamydial infections: prevention and treatment". Paediatr Drugs. 7 (2): 103–10. PMID 15871630.
  17. ↑ Nahmias AJ, Visintine AM, Caldwell DR, Wilson LA (1976). "Eye infections with herpes simplex viruses in neonates". Surv Ophthalmol. 21 (2): 100–5. PMID 982267.
  18. ↑ Centers for Disease Control and Prevention (2015) http://www.cdc.gov/std/tg2015/screening-recommendations.htm Accessed on June 29, 2016
  19. ↑ Centers for Disease Control and Prevention (2002) http://www.cdc.gov/mmwr/PDF/rr/rr5115.pdf Accessed on June 29, 2016
  20. ↑ 20.0 20.1 20.2 Matejcek A, Goldman RD (2013). "Treatment and prevention of ophthalmia neonatorum". Can Fam Physician. 59 (11): 1187–90. PMC 3828094. PMID 24235191.
  21. ↑ Rours, Ingrid GIJG, et al. "Chlamydia trachomatis as a cause of neonatal conjunctivitis in Dutch infants." Pediatrics 121.2 (2008): e321-e326.
  22. ↑ 22.0 22.1 Pickering, Larry K. Red book®: 2003 report of the committee on infectious diseases. No. Ed. 26. American Academy of Pediatrics, 2003.
  23. ↑ Jhanji V, Chan TC, Li EY, Agarwal K, Vajpayee RB (2015). "Adenoviral keratoconjunctivitis". Surv Ophthalmol. 60 (5): 435–43. doi:10.1016/j.survophthal.2015.04.001. PMID 26077630.
  24. ↑ Høvding G (2004). "[Acute bacterial conjunctivitis]". Tidsskr Nor Laegeforen. 124 (11): 1518–20. PMID 15195156.
  25. ↑ Høvding G (2008). "Acute bacterial conjunctivitis". Acta Ophthalmol. 86 (1): 5–17. doi:10.1111/j.1600-0420.2007.01006.x. PMID 17970823.
  26. ↑ Quinn, Christopher J.; Mathews, Dennis E. (Nov 8 2002). "Optometric clinical practice guideline care of the patient with conjunctivitis". Check date values in: |date= (help)
  27. ↑ McLeod, Stephen D.; Feder, Robert S. (2013). "Conjunctivitis: Preferred Practice Pattern - American Academy of Ophthalmology".
  28. ↑ Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2010. MMWR Morb Mortal Wkly Rep 2010;59 (No. RR-12):55.

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