ophthalmia%20neonatorum
OPHTHALMIA NEONATORUM
Ophthalmia neonatorum is conjunctivitis occurring in a newborn during the first month of life.
It is also called neonatal conjunctivitis.
Organisms causing neonatal conjunctivitis are usually acquired from the infected birth canal of the mother during vaginal delivery, though some may acquire the infection from their immediate surroundings.
It is one of the leading cause of blindness in infants via corneal ulceration and subsequent opacification or perforation and endophthalmitis.

Principles of Therapy

  • Treatment is basically based on the clinical picture & laboratory diagnosis
  • Infants should be hospitalized to monitor response to treatment especially those w/ septic neonatal conjunctivitis
  • Systemic treatment is usually given rather than topical drugs in order that systemic dissemination may be prevented

Pharmacotherapy

Acyclovir
  • Treatment option for viral neonatal conjunctivitis
    • Recommended dosage: 30 mg/kg/day intravenous (IV) divided to 3 doses for at least 2 weeks
  • By competing w/ deoxyguanosine triphosphate for viral DNA polymerase & by incorporation into viral DNA, it inhibits viral replication
Aminoglycosides
  • Eg Tobramycin, Gentamicin
  • Gentamicin is an alternative treatment for gonococcal neonatal conjunctivitis
    • Recommended dosage: intramuscular dose twice daily for 1 week
  • Tobramycin & Gentamicin may be used as treatment for gram-negative bacteria causing neonatal conjunctivitis (except N. gonorrhea)
    • Recommended dosage: Ointment or drops 4 times a day
Azithromycin
  • Alternative treatment for patients w/ chlamydial conjunctivitis intolerant to Erythromycin
    • Recommended dosage: 20 mg/kg/day orally for 3 days
    • Studies proving the efficacy of Azithromycin for chlamydial conjunctivitis are limited
Cefotaxime
  • Treatment option for neonates w/ gonococcal conjunctivitis & hyperbilirubinemia
    • Recommended dosage: 100 mg/kg IV or intramuscular (IM)
Ceftriaxone
  • Drug of choice for gonococcal neonatal conjunctivitis
    • Recommended dosage: 25-50 mg/kg IV or IM as a single dose, not to exceed 125 mg
    • Topical antibiotic therapy alone is inadequate & is unnecessary when systemic treatment is administered
  • Inhibits bacterial growth by binding to one or more of the penicillin-binding proteins
  • Use w/ caution in infants who is born prematurely & w/ hyperbilirubinemia
Erythromycin
  • Drug of choice for chlamydial neonatal conjunctivitis
    • Recommended dosage: 50 mg/kg/day orally in 4 divided doses for 14 days
    • Topical antibiotic therapy alone is inadequate & is unnecessary when systemic treatment is administered
    • Advantages of oral Erythromycin include: Eradication of the nasopharyngeal carriers, treatment of associated pneumonitis & also being more effective than topical in preventing relapse of conjunctivitis
    • A second course of treatment may be required thus monitoring the response to treatment is necessary
  • Also used for treatment of other gram-positive bacteria causing neonatal conjunctivitis
    • Dosage: 0.5% ointment 4 times a day
  • May cause infantile hypertrophic pyloric stenosis
    • Signs & symptoms of this disease (eg intestinal obstruction) should be monitored
Penicillin G
  • Alternative treatment for gonococcal neonatal conjunctivitis
    • Recommended dosage: 100,000 units/kg/day IV in 4 divided doses for 1 week
  • Inhibits bacterial growth by binding to one or more of the penicillin-binding proteins
Trifluridine (Trifluorothymidine)
  • Treatment option for viral neonatal conjunctivitis
    • Recommended dosage: 1% ophthalmic drops every 2 hours for 7 days
  • Inhibits viral replication by incorporating into the viral DNA in place of thymidine
Vidarabine
  • Adjunct therapy to Acyclovir for the treatment of viral neonatal conjunctivitis
Prophylaxis
  • Easy to administer, safe & inexpensive in preventing sight-threatening gonococcal neonatal conjunctivitis
Erythromycin
  • Drug of choice for neonatal conjunctivitis prophylaxis
    • Recommended dosage: 0.5% Erythromycin ointment 1 cm ribbon in each eye as single dose applied as soon as possible after birth
    • Preferred prophylaxis than silver nitrate due to less incidence of chemical conjunctivitis
    • Effective prophylaxis for gonococcal neonatal conjunctivitis but not in chlamydial neonatal conjunctivitis
  • Inhibits bacterial growth by inhibiting bacterial RNA-dependent protein synthesis
Povidone-iodine
  • Alternative prophylaxis for chlamydial neonatal conjunctivitis
    • 2.5% ophthalmic soln in each eye applied as soon as possible after birth
  • Studies have shown that it has superior bactericidal effects & also active against viruses but further studies are recommended
Silver nitrate
  • More effective as a prophylaxis for N. gonorrhea than Erythromycin & should be used in areas where that organism is prevalent
  • Not effective prophylaxis for C. trachomatis
  • Usage as prophylaxis is discouraged as it can cause chemical neonatal conjunctivitis
Tetracycline
  • Alternative prophylaxis for chlamydial neonatal conjunctivitis
    • Recommended dosage: 1% Tetracycline ointment 1 cm ribbon in each eye as single dose applied as soon as possible after birth
  • Inhibits bacterial protein synthesis by binding to the 30S & possible the 50S ribosomal subunits of susceptible bacteria preventing additions of amino acids to the growing peptide chain

Non-Pharmacological Therapy

Observation
  • Chemical conjunctivitis usually resolves w/in 24-36 hours unless there is bacterial infection complication
Normal saline irrigation
  • In gonococcal conjunctivitis, normal saline irrigation helps remove the mucopurulent debris from the lids & conjunctiva
    • May be performed 4 times a day
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