Conjunctivitis neonatal

Glutaric aciduria type II, which is a defect of P-oxida-tion, may affect muscle exclusively or in conjunction with other tissues. Glutaric aciduria type II, also termed multiple acyl-CoA dehydrogenase deficiency (Fig. 42-2), usually causes respiratory distress, hypoglycemia, hyperammonemia, systemic carnitine deficiency, nonketotic metabolic acidosis in the neonatal period and death within the first week. A few patients with onset in childhood or adult life showed lipid-storage myopathy, with weakness or premature fatigue [4]. Short-chain acyl-CoA deficiency (Fig. 42-2) was described in one woman with proximal limb weakness and exercise intolerance. Muscle biopsy showed marked accumulation of lipid droplets. Although... 

Chlamydia infection can be transmitted at birth to the neonate and cause conjunctivitis and a subacute, afebrile pneumonia with onset at 1 to 3 months. 

Although erythromycin is a well-established antibiotic, there are relatively few primary indications for its use. These indications include the treatment of Mycoplasma pneumoniae infections, eradication of Corynebacterium diphtheriae from pharyngeal carriers, the early preparox-ysmal stage of pertussis, chlamydial infections, and more recently, the treatment of Legionnaires disease, Campylobacter enteritis, and chlamydial conjunctivitis, and the prevention of secondary pneumonia in neonates. 

Developmentally, microsomal 25-OHase activity is low 3 days prior to birth in rat foetuses [129]. After birth, 25-OH-D3 production steadily increases for the first two weeks of neonatal life and then increases six-fold more in the third week. Maternal 25-OH-D3 production increases slightly the day of parturition and 22 days postpartum. Therefore, the microsomal 25-OHase appears to be fully activated in conjunction with the time of weaning. 

To achieve greater pupillary dilation and overcome the constrictor effect of cholinergic stimulation, particularly on exposure to bright illumination, both phenylephrine and hydroxyamphetamine can be used in conjunction with a cholinergic antagonist, such as tropicamide or cyclopentolate. Additionally, phenylephrine 1% combined with a low concentration of 0.2% cyclopentolate (Cyclomydril) is recommended for neonates for funduscopic examinations. 

Allergic blepharitis Contact dermatitis Herpes zoster dermatoblepharitis Chemical burns Neonatal hemangioma Conjunctiva Allergic conjunctivitis Vernal conjunctivitis Herpes zoster conjunctivitis Chemical burns... 

Herpetic conjunctivitis is usually a manifestation of primary HSV infection, which generally occurs in children between the ages of 6 months and 5 years. Most cases of herpetic ocular infection result from the nonvenereal form of the virus (HSV-1). Ocular infection with HSV-2 can occur in both newborns and adults. Infection may result from contact with the virus in the infected birth canal (herpetic neonatal conjunctivitis) or from autoinoculation after sexual contact with an infected partner. 

Neisseria gonorrhoeae Ophthalmia Neonatorum. Gonococcal neonatal conjunctivitis is characterized by the neonate s development of hyperacute conjunctivitis between 2 and 5 days postpartum. Most cases of neonatal gonococcal conjunctivitis are bilateral periorbital edema, chemosis, and purulent exudate are prominent (Figure 25-18). 

Figure 25-18 Neonatal conjunctivitis secondary to Neisseria gonorrhoeae. Note the copious purulent exudates and pronounced chemosis. (Courtesy William Wallace, O.D.)...

Herpes Simplex Virus Ophthalmia Neonatorum. HSY infection is an uncommon but important cause of neonatal infection and is associated with conjunctivitis in 5% to 10% of cases.The clinical manifestations are nonspecific and include conjimctival hyperemia, chemosis, periorbital edema, and mucous discharge. Corneal involvement is not uncommon and can include dendritic, geographic, or stromal keratitis. Herpetic ophthalmia neonatorum represents a primary herpetic infection. Central nervous system involvement, encephalitis, retinitis, optic neuritis, uveitis, choroiditis, and a fetal viremia can be serious sequelae of primary herpetic infections. 

The prognosis for an infent with neonatal HSV infection is guarded. Treatment of the conjunctivitis should include topical 1% trifluridine every 2 hours until the infection begins to resolve and then tapered according to the clinical response. Systemic therapy with intravenous acyclovir is indicated in the presence of viremia and disseminated disease. 

Prevention. The best method for preventing neonatal conjunctivitis is the diagnosis and treatment of infections in pregnant women through appropriate prenatal care. In 1881 Crede first described the advantage of silver nitrate prophylaxis for the prevention of gonococcal infection. Since that time the incidence of infection from... 

Sandstorm KI, BeU TA, Chandler JW, et al. Microbial causes of neonatal conjunctivitis. J Pediatr 1984 105 706-711. 

Chlamydial conjunctivitis. In the developed world, the genital (D-K) serotypes of the organism are responsible and the reservoir and transmission is maintained by sexual contact. Endemic trachoma in developing countries is usually caused by serotypes A, B and C. In either case, oral tetracycline is effective. Pregnant or lactating women may receive sys-teiiuc erythromycin. Neonatal ophthalmia should be treated with systemic erythromycin and topical tetracycline. 

The variability associated with drug absorption from the gastrointestinal tract can be overcome by using a parenteral preparation (dosage form). It should preferably be administered either by intravenous infusion or slow intravenous injection to avoid circulatory overload. Intraosseous administration is a useful alternative to intravenous injection of some antimicrobial agents (e.g. sodium ampicillin or amoxycillin, cefotaxime, ceftriaxone, gentamicin or amikacin sulphate) in neonatal foals (Fig. 7.1) (Golenz et al, 1994) and puppies (Lavy et al, 1995). This particularly applies when the neonate is in a state of septic shock and/or dehydration. Total plasma protein concentration is an inaccurate index of hydration status unless monitored (repeatedly measured) and interpreted in conjunction with packed cell volume (PCV). 

The equilibrium position of this reaction is 6 X 10 which is quite unfavorable for the synthesis of acetoacetyl-CoA. However, as will be pointed out below, when it functions in conjunction with the next enzyme in the sequence, synthesis is favored. The turnover number in the forward direction (as written) was found to be 1770 while that of the reverse was 54000. The enzyme from mitochondria has two electrophoretically distinct forms, and the cytoplasmic enzyme could be clearly distinguished from the two mitochondrial proteins by the difference in their isoelectric points. Middleton surveyed many tissues from rat as well as selected tissues from ox and pigeon for both the cytoplasmic and the mitochondrial enzymes. The highest levels of the cytoplasmic enzyme were found in the liver, adrenal, brciin of the neonate, and ileum [14,15]. There was an obvious positive correlation between sterol biosynthetic capacity and the distribution of this enzyme. The mitochondrial enzyme was found predominantly in heart, kidney, and liver. The cytosolic enzyme has also been highly purified from rat liver [16]. 

Ophthalmic use for treatment of superficial ocular infections caused by strains of susceptible organisms and prophylaxis of neonatal conjunctivitis. 

Once these causes of jaundice have been excluded, neonatal hepatitis, biliary atresia (BA) or duct paucity syndromes will account for more than two thirds of the remaining cases of conjugated hyperbilirubinemia in the neonate. In conjunction with nuclear medicine, US is the primary imaging modality for differentiating among these diseases and differentiation is important, as surgery is the treatment for BA but not for the other entities (Kelly 1999 Mortele et al. 2006 Gazelle et al. 1998). 

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