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Sunday, January 29, 2017

Neonatal Conjunctivitis - A Brief Discussion

Neonatal conjunctivitis is acquired either during birth with passage through the mother’s cervix and vagina, or from cross-infection in the neonatal period.

Etiologies: More common etiologies include Chlamydia trachomatis, viruses (herpes simplex), and bacteria (Staphylococcus aureus, Streptococcal pneumoniae, Haemophilus species).

Clinical Features: 

  • Presenting symptoms for Neisseria gonorrhoeae infection include a hyperacute bilateral conjunctivitis with copious purulent discharge, lid swelling, chemosis, and preauricular adenopathy.

            Thick purulent drainage in a newborn diagnosed with neonatal gonococcal conjunctivitis.

  • For chlamydial conjunctivitis, the clinical features range from mild swelling with a watery discharge to marked lid swelling with a red and thickened conjunctiva with a blood-stained discharge. 
  • Fluorescein staining of herpes simplex conjunctivitis demonstrates epithelial dendrites.
  • Blindness can result from gonococcal eye infection in the neonate because the organism can invade the cornea. It is one of the few emergency conjunctival infections.
  •  Nasolacrimal duct obstruction is common (up to 20%) in newborns and may present with findings suggestive of conjunctivitis. It is a diagnosis of exclusion in the neonate.

            A scant crusty discharge is seen in this newborn who was diagnosed in follow-up with                         nasolacrimal duct obstruction



Diagnosis: With any form of neonatal conjunctivitis, Gram stain and culture are indicated. Scrapings of the palpebral conjunctiva are more likely to be rewarding than examination of the discharge

itself. 

The “rule of fives” may help predict the most likely bacterial cause.
0-5 days.......................Gonococcus
5 days-5 weeks............Chlamydia
5 weeks-5 years..........Staphylococcus, Streptococcus, Haemophilus

Treatment: Begin treatment in the emergency department (ED) and admit newborns with suspected gonococcal conjunctivitis.
Evaluate concurrently for C trachomatis, since coinfection is common.

Treatment for chlamydial conjunctivitis is based upon a positive diagnostic test. While culture is the gold standard, nucleic acid amplification tests, despite lacking FDA approval, are reported to perform similarly. 

Untreated disease can result in corneal and conjunctival scarring. 
  • Bacterial neonatal conjunctivitis that is neither gonococcal nor chlamydial may be treated with erythromycin antibiotic ointment and should be reevaluated in 24 hours.
  • Herpes simplex conjunctivitis is treated with intravenous (IV) acyclovir and topical trifluridine. Despite the appearance of a localized herpes infection, there is high risk for central nervous system (CNS) or disseminated infection.
Evaluation of the newborn’s parents should be undertaken in neonatal conjunctivitis due to Gonococcus, Chlamydia, or herpes simplex virus (HSV).

1. Chemical Neonatal Conjunctivitis: Seen on day 1. and is common with use of silver nitrate for prophylaxisis. (erythromycin more commonly used now for this reason). It is self limited and needs no treatment. 

2. N gonorrhoeae Conjunctivitis: Appears between day 2-7, and may cause hyperacute disease with profuse discharge. Treatment is with Ceftriaxone IV. (Caution in hyperbilirubinemia.) Topicals treatment alone is inadequate.

3. C trachomatis Conjunctivitis: Appears between day 3-14. Clinical severity varies and it is a common cause of blindness worldwide. Treatment with Erythromycin. 

4. HSV 1,2: Appears anytime between day 2 &16 and should be suspected if child has any vesicular lesions on body. Treatment is with Vidarabine or trifluridine topically; consider systemic acyclovir.

2 comments:


  1. I feel so excited today because it's just a year since I got my breakthrough from Herpes.I was diagnosed of HSV1 on the 12/4/2015 and latter i got affected with the HSV2. That was my 2nd outbreak after i lost my ex fiance that got me affected with the virus. I was so scared when he died and what i heard about the Herpes virus as he's deathly and such has no cure. I feel so pity and and a disgrace to my personality,in my career and my family to have been in with the deathly sickness, and that would makes my love ones siblings stay far from me. I was going to my regular church activities when i begin to hear testimonies of how people get cure online, i never gave it a thought till my cousin Stephanie who was affected with HIV told me, Lenny you need not to worry cos i met i man today online , i traditional herbal healer whom two of her friends confirmed he cure them with his herbal herbs that i should give it a try. I saw the interest in her and she did contact the herbal doctor again in my present, luckily for me he picked and show up himself, behold he was at about to attain to some patients that have came back with appreciation of how he cure them from Cancer, HIV, and off much too the herpes he cured an 18 years old daughter.
    I was so happy that day, i wanted to be there but the distance was a barrier to me. I told him how the virus had eaten me up and and a truly believe there's cure for herpes. He told me me with assurance that my case wont be different and he had been curing lots of people With his herbal medicine and most people due contact him from the States and preperd the medicine and made use of the DHL to reach him.
    Honestly speaking Dr. Akpu power his a great and gifted herbalist,His destined to herbs.
    He made me do away with the medical prescription,the acyclovir (Zovirax), famciclovir(Famvir), and valacyclovir (valtrex). you don't know him because you haven't meet this man try and contact him yourself Dr. Akpu in Africa is popularly known in his City,and you can request for his address yourself. I'm so happy now cos,I and my cousin had been confirmed negative till date..the Lord is good in my life. Dr. Akpu sent me his herbal medicine that heal me too, 🙏 🙏 Dr. Akpu for giving me another life.
    Contact Dr.akpu for all kids of sickness@
    Dr.akpupowerherbscenter@gmail.com

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  2. I started on COPD Herbal treatment from Ultimate Health Home, the treatment worked incredibly for my lungs condition. I used the herbal treatment for almost 4 months, it reversed my COPD. My severe shortness of breath, dry cough, chest tightness gradually disappeared. Reach Ultimate Health Home via their website at www.ultimatelifeclinic.com I can breath much better and It feels comfortable!

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