Ophthalmia
neonatorum, also known as neonatal conjunctivitis,
is an aseptic or septic conjunctival inflammation of neonate’s eyes within the first
28 days of birth. The causes are variable, may or may not be due to a pathogen,
i.e., it can be merely due to the lacrimal duct obstruction or an irritant.
The infectious causes of sticky eyes include bacteria
and viruses. The former includes Chlamydia trachomatis, Neisseria gonorrhoea, Haemophilus
influenza, Staphylococcus aureus, and Moraxella catarrhalis, while the latter
includes Herpes simplex virus and Adenovirus.
Chlamydia is the most
common bacterial cause, followed by Gonococcal ophthalmia.
When a neonate presents within first 3 to 5 days of birth
(up to 14 days of birth) with serosanguinous or mucopurulent discharge, eyelid
edema, and conjunctival injection, think of Chlamydial ophthalmia
Chlamydial ophthalmia, although presents around 5 to 14
days after birth, it may be seen as late as 60 days of birth. Usually, it starts
unilaterally, then spreads to the other eye, so the presentation can be both
uni- or bilateral.
How does the neonate get infected?
The maternal cervix and urethra are reservoirs of Chlamydia.
A baby born vaginally to a mother with diagnosed chlamydial cervicitis has up to
75% chance[i]
of acquiring the bacteria, out of which 30-50% develop an infection, such
as conjunctivitis. Since C.trachomatis is the most common sexually transmitted
infection, it also accounts for 40%[ii]
of conjunctivitis in neonates within the first 28 days of birth.
If a mother is diagnosed case of cervicitis with Chlamydia,
her symptomatic neonate should be treated empirically while waiting for the
test results.
Does Chlamydial ophthalmia have complications? لعب روليت مجاني
Most of the cases spontaneously resolve, however, 10-20%
of the infected neonates may develop pneumonia. Loss of vision is rarely seen
with Chlamydial ophthalmia.
To
understand better, here is a case presentation[iii]:
The
parents of a 2-week-old baby girl brought her to the ophthalmology
clinic with complaints of purulent discharge bilaterally, for 3 days. The baby was
delivered vaginally at term without any intrapartum complications. The patient’s
notes showed no record of ocular prophylaxis after delivery. During the antenatal
period, the mother was neither tested for chlamydia or gonorrhea infection.
The neonate’s
clinical presentation was suggestive of ophthalmia neonatal. To identify the cause,
samples were obtained from the neonate’s prurient discharge and mother’s cervix
via endocervical swab.
Both samples
tested positive for Chlamydia trachomatis DNA.
Since Chlamydia
and N.gonorrhea coexist in the maternal cervix, it is imperative to rule out N.gonorrhoea
too. Therefore, the same samples were also tested for gonorrhea and came out negative.
The
newborn was started on oral erythromycin for 2 weeks, and each parent has
prescribed a single dose of azithromycin.
After starting the antibiotic, the symptoms resolved within 5 days. المراهنات الرياضية At a
2-week follow-up, the baby was healthy with no long term complications.
References:
[i] Matejcek, A., & Goldman, R. D. (2013). Treatment and prevention of ophthalmia neonatorum. Canadian family physician Medecin de famille canadien, 59(11), 1187–1190.
[ii] Brenda L. Tesini, M. U. (2018, July). Neonatal Conjunctivitis. Retrieved from MSD Manual Professional Version: https://www.msdmanuals.com/professional/pediatrics/infections-in-neonates/neonatal-conjunctivitis
[iii] Aik-Kah Tan, M. (2019, January 10). Ophthalmia Neonatorum. Retrieved from The New England Journal of Medicine: https://www. موقع بيت 365 لكرة القدم nejm.org/doi/full/10.1056/NEJMicm1808613
