Ophthalmia neonatorum

Ceftriaxone 25 to 50 mg/kg intravenously or intramuscularly as a single dose for ophthalmia neonatorum or infants born to mothers with gonococcal infection as prophylaxis... 

Treatment of gonorrhea during pregnancy is essential to prevent ophthalmia neonatorum. The CDC recommends that either tetracycline (1%) ophthalmic ointment or erythromycin (0.5%) ophthalmic ointment be instilled in each conjunctival sac immediately postpartum to prevent ophthalmia neonatorum. 

For prophylaxis of ophthalmia neonatorum, various groups have proposed the use of erythromycin (0.5%) or tetracycline (1%) ophthalmic ointment in lieu of silver nitrate. Although silver nitrate and antibiotic ointments are effective against gonococcal ophthalmia neonatorum, silver nitrate is not effective for chlamydial disease and may cause a chemical conjunctivitis. 

Tetracycline and erythromycin Tetracycline and erythromycin also are indicated for the prophylaxis of ophthalmia neonatorum caused by Neisseria gonorrhoeae or Chlamydia trachomatis. 

Biological and medicinal aspects of silver chemistry are covered in Chapter 62 but a number of features will be outlined here. Silver salts are powerful bacteriocides and it has been known for many years that storing water in silver vessels prevents spoilage. Silver nitrate is highly corrosive and can be applied locally to remove warts or cauterize wounds. In many states in the USA, a 1% AgN03 solution is dropped into the eyes of newborn infants to prevent ophthalmia neonatorum. Silver sulfadiazine has been found effective as a topical application to prevent infections in serious bums victims. 

Gonococcal conjunctivilis in adults Ophthalmia neonatorum Infants bom to mothers with gonococcal infection (prophylaxis)... 

A fixed-combination ointment containing oxytetracy-cline and polymyxin B is available for topical ocular use (see Table 11-6). The Centers for Disease Control and Prevention recommends ophthalmic ointments containing a tetracycline or erythromycin as an effective alternative to silver nitrate for prophylaxis of gonococcal ophthalmia neonatorum. A major advantage of using an antibiotic ointment such as oxytetracycline-polymyxin B is that it does not canse the chemical conjunctivitis typically produced by silver nitrate. 

Staphylococcal infections of the eyelid are commonly treated with erythromycin ointment applied to the Ud margins (see Table 11-1). Warm moist compresses should be applied to the lid, and then the lid margins should be gently cleaned with diluted baby shampoo or a commercial lid cleanser before applying the drug. Erythromycin ointment can be applied only at bedtime or more often as required by infection severity. For the prophylaxis of ophthalmia neonatorum, a 0.5- to 1-cm ribbon of erythromycin ointment is instilled into each conjunctival sac and not flushed from the eyes after application. 

Severe chronic conjunctivitis Hyperacute conjunctivitis Ophthalmia neonatorum Membranous conjunctivitis Parinaud s oculoglandular syndrome Postoperative infections... 

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). 

Chlamydial ophthalmia neonatorum is characterized by the onset of a mild to moderate unilateral or bilateral mucopurulent conjunctivitis 5 to 14 days postpartum (Figure 25-20). Eyelid edema, chemosis, and conjunctival membrane or pseudomembrane formation may also accompany this condition. Corneal findings occasionally include punctate opacities and micropannus formation. Ophthalmia neonatorum secondary to C. trachomatis was once considered a benign and self-limited condition. However, systemic chlamydial infection, especially pneumonitis, is now well recognized in patients with chlamydial conjunctivitis. More than 50% of infants who develop chlamydial pneumonitis may also have ophthalmia neonatorum. 

Diagnosis of chlamydial ophthalmia neonatorum is estabUshed by conjunctival smears that reveal typical basophihe intracytoplasmic inclusions with Giemsa stain and by traditional specimen culture (Figure 25-21). Direct immunofluorescent, immunoenzyme antibody or NAAT testing can also be helpful in confirming the diagnosis. 

Optimal treatment of chlamydial ophthalmia neonatorum has not been determined. The CDC recommends erythromycin base or ethylsuccinate syrup 50 mgAg/day orally divided into four doses daily for 14 days. Topical antibiotic therapy alone is inadequate and unnecessary when systemic treatment is administered. Another important aspect of treatment is concurrent therapy for the mother and her sexual partners. 

Clinical manifestations of bacterial ophthalmia neonatorum are nonspecific and similar to those caused by other pathogens discussed previously. Infants experience the acute onset of hyperemia, chemosis, eyelid edema, and purulent or mucopurulent exudate 5 to 21 days postpartum. Practitioners should take care to rule out nasolacrimal duct obstruction, a finduig that is relatively common in newborns and that can be associated with a secondary bacterial infection. 

Because the etiology of ophthalmia neonatorum cannot be distinguished on the basis of clinical examination alone, laboratory investigations (smears and cultures) are mandatory. Differentiation of bacterial infections, particularly Pseudomonas, is important, because pseudomonal infections in premature infents can lead to septicemia and death if not aggressively and appropriately treated. 

Initial treatment of bacterial ophthalmia neonatorum should be directed by the results of conjimctival smears. Broad-spectrum antibiotics with low toxicity should be used. Topical erythromycin or tetracycline ointment can be used four to six times daily fc>r gram-positive organisms, and gentamicin or tobramycin solution four to six times daily can be started if gram-negative organisms are isolated. Trimethoprim-polymyxin B (Polytrim) has... 

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. 

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