Neonatal Conjuctivitis

Table of Contents:

• Chemical Neonatal Conjunctivitis
• Neonatal Gonococcal Conjunctivitis
• Chlamydial Neonatal Conjunctivitis

In this module, we're going to focus on neonatal conjunctivitis.

There are three high-yield subtypes of neonatal conjunctivitis to be aware of your examinations. These include: 

• Chemical Neonatal Conjuctivis
• Neisseria Gonorrhea
• Chlamydia Trachomatis.

When we use the term conjunctivitis, we're referring to inflammation of the conjunctiva, which essentially wraps around the front of the eye and also covers the inside of the eyelids.

 

Chemical Neonatal Conjunctivitis.

In chemical neonatal conjunctivitis, the patient will present with bilateral watery discharge and may also have conjunctival injection, which is redness of the conjunctiva. It is important to note here is it is going to present within the first 24 hours following delivery.

Pathophysiology

The classic pathophysiology for chemical conjunctivitis is the use of silver nitrate. Silver nitrate traditionally was applied topically to the eyes in order to prevent gonococcal conjunctivitis.

In recent years, however, we have switched as a medical community from silver nitrate to Arithromycin as our go-to prophylactic agent. As a result of this chemical, conjunctivitis is a lot less common than it once was.

Given that this is due to chemical irritation rather than an actual bacterial or viral infection, the gram stain is going to be negative in these patients.

Management

We can simply give these patients a lubricant. There is no need for an antibiotic or anything of that nature, as this is simply a result of chemical irritation.

Neonatal Gonococcal Conjunctivitis

This is going to present with bilateral conjunctival injection or redness of the eyes. However, classically, this is also going to present with purulent rather than watery discharge.

This purulence suggests that we have this underlying bacterial infection.

These patients may also present with swelling of the eyelids, exudates, and in some cases, even ulceration. Unlike chemical conjunctivitis, which presents in the 24 hours after birth.

In the case of gonococcal conjunctivitis, this is going to present two to five days after birth.

Pathophysiology

The pathophysiology of this is perinatal transmission of the infection.

Diagnosis

Unlike in the case of chemical conjunctivitis, we can get a gram stain and culture in these patients, which will be quite helpful.

Classically this gram stain will reveal Gram-negative diplococci, which is shown below.

 

Management

For patients who have an active gonococcal conjunctivitis infection, we can treat these patients with a third-generation cephalosporin, such as Ceftriaxone or Cefotaxime.

Ultimately the possibility of developing this pretty severe gonococcal conjunctivitis is the reason why we give Topical Erythromycin as a prophylaxis agent for all of our newborns.

Chlamydial Neonatal Conjunctivitis

This is going to present with bilateral conjunctival injection as well as eyelid swelling.

Additionally, these patients may have bloody or purulent discharge from the eyes.

Although chlamydia conjunctivitis does have some features in common with gonococcal conjunctivitis, the real key to differentiating these two conditions is the timeline.

As in chlamydia conjunctivitis, this is going to present 5 to 14 days after birth.

Pathophysiology

It is a perinatal infection.

Diagnosis

We can detect the presence of chlamydia Using Nucleic Acid Amplification Testing, also known as NAAT.

Management

We treat these patients with PO Erythromycin.

As we conclude this brief module, keep in mind the timeline of these three key types of conjunctivitis:

1. Chemical Conjunctivitis occurs within the first 24 hours after birth.
2. Gonococcal conjunctivitis occurs three to five days after birth and
3. Chlamydia Conjunctivitis occurs five to 14 days after birth.