| ID | 367 |
|---|---|
| Name | OPHTHALMIA NEONATORUM (It is a unilateral or bilateral purulent conjunctivitis occuring in the new born within the first 4 weeks of life.) |
| Cause | Chemical. Bacterial. Chlamydia trachomatis. Neisseria gonorrhoeae. Haemophilus species. Streptococcus pneumoniae. Staphylococcus aureus. Staphylococcus epidermidis. Streptococcus viridans. Escherichia coli. Pseudomonas aeruginosa. Other. Viral. Adenovirus. Herpes simplex virus. |
| Signs Symptoms | Eyelid edema, erythema, and purulent discharge causing corneal perforation, endophthalmitis, blindness, and possibly death. |
| Diagnosis | Diagnosis: 1. Conjunctival smear shows gonococci, (gm-ve intracelluler diplococci). 2. Conjunctival swab for C/S. 3. Scrapings from the palpebral conjunctiva- typical cytoplasmic inclusions may be present |
| Investigations | Conjunctival scraping for Gram stain or Giemsa stain |
| Management | Systemic, topical, or combined antimicrobial therapy Neonates with conjunctivitis and known maternal gonococcal infection or with gram-negative intracellular diplococci identified in conjunctival exudates should be treated with ceftriaxone or cefotaxime In chlamydial ophthalmia, systemic therapy is the treatment of choice. Erythromycin ethylsuccinate 12.5 mg/kg orally every 6 hours for 2 weeks or azithromycin 20 mg/kg orally once a day for 3 days is recommended. A neonate with gonococcal ophthalmia is hospitalized for evaluation of possible systemic gonococcal infection and given a single dose of ceftriaxone 25 to 50 mg/kg IM or IV to a maximum dose of 125 mg. Infants with hyperbilirubinemia or those receiving calcium-containing fluids should not receive ceftriaxone and may be given a single dose of cefotaxime 100 mg/kg IV or IM. Frequent saline irrigation of the eye prevents secretions from adhering. Conjunctivitis due to other bacteria usually responds to topical ointments containing polymyxin plus bacitracin, erythromycin, or tetracycline. Herpetic keratoconjunctivitis should be treated (with an ophthalmologist’s consultation) with systemic acyclovir 20 mg/kg every 8 hours for 14 to 21 days and topical 1% trifluridine ophthalmic drops or ointment, vidarabine 3% ointment, or 0.1% iododeoxyuridine every 2 to 3 hours, with a maximum of 9 doses/24 hours. Systemic therapy is important because dissemination to the central nervous system and other organs can occur. Corticosteroid-containing ointments may seriously exacerbate eye infections due to C. trachomatis and herpes simplex virus and should be avoided. |
| Introduction | |
| History | |
| Etiology | Etiology: Conjunctivitis is frequently encountered in the new born infant due to infections caused by- 1. Neisseria gonorrhoee 2. Chlamydia trachomatis 3. Staphylococcus Aureus. And less commonly by- 4. Group A&D streptococci 5. Pseudomonas eroginosa & 6. Herpes virus Infections are usually acquired during passage through a colonised or infected birth canal or by cross-infection from attendents after birth. Sometime inflammation may occur secondary to silver nitrate dropping, used as a prophylactic eye drop. |
| Clinical Features | Clinical features: 1. Pain and tenderness of the eyeball 2. Conjunctiva appears bright red and velvety. It may be chemosed. 3. Pre-auricular glands are enlarged. 4. Discharges are frankly purulent and aboundant and thick; creamy pus drips down the cheeks. |
| Preventions | The World Health Organization (WHO) recommends the following treatments to prevent ophthalmia neonatorum: tetracycline hydrochloride 1% eye ointment; erythromycin 0.5% eye ointment; povidone‐iodine 2.5% solution (water‐based) |
| Treatment | Treatment: A. Prophylactic- 1 Regular antenatal care of the mother. Examination and treatment of the mother for any infection. 2. Adequate hygiene at birth. 3 Social measure should be taken to stop illegitimate relationship. 4. Immediately after birth, the eye of the baby should be irrigated initially with saline every 10-30 mins, then gradually increasing to 2-hour intervals until the purulent discharge has cleared. B. Curative- Continuous saline irrigation should be done until the eyes are cleaned. Specific treatment according to etiology: 1. For staphylococcus- Framycetin 0.5% eye drops 1-2 drops 6 hourly. 2. For gonococcus- Inj. ceftriaxone 50mg/kg/day in single dose (not exceeding 125mg daily) by i.v infusion for 7 days. Or alternatively, cefotaxime l00mg/kg/day can be given i.v or i.m every 12 hour for 7 days, or lOOmg/kg as a single dose. 3. A broad spectrum antibiotic ointment should be applied at bedtime. 4. For C. trachomatis- sulphacetamide eye drop for 14-21 days. 5. In case of pseudomonas neonatal conjunctivitis an additional aminoglycoside should be given with systemic antibiotic. 5. Treatment of complications (if any). |
| Complications | Complications: 1. Corneal ulceration. 2. Adherent leucoma. 3. Cornea may sloughout, causing anterior staphyloma. 4. Permanent scarring. 5. Nystagmus. |
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