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IN THE NAME OF GOD

IN THE NAME OF GOD. Neonatal Conjunctivitis Or Ophthalmia Neonatorum S . Ghaemi .MD. Conjunctivitis is the most common ocular diseases in neonates and the prevalence rate in the world is about 20% and in the united states is 2%. Etiology :. Chemical Chlamydial Bacterial Viral.

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IN THE NAME OF GOD

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  1. IN THE NAME OF GOD

  2. Neonatal ConjunctivitisOr Ophthalmia Neonatorum S . Ghaemi .MD

  3. Conjunctivitis is the most common ocular diseases in neonates and the prevalence rate in the world is about 20% and in the united states is 2%.

  4. Etiology : • Chemical • Chlamydial • Bacterial • Viral

  5. Time of presentation according to etiology of conjunctivitis

  6. Chlamydia trachomatis (Inclusion blennorrhea) • C. trachomatis infection is the most common form of ophthalmia neonatorum today . • Occurring in up to 1% of births in developed countries.

  7. Is primarily transmited to newborn via exposure to an infected mother’s genital flora during vaginal birth and it causes neonatal conjunctivitis between 20-50% and pneumonia about 10-20%.

  8. Clinical manifestations • The incubation period is 5-14 days after delivery . • Presentation occurs earlier in PROM • Clinical findings range from→ mild swelling with a watery eye discharge → to marked swelling of eyelids witch becomes mucopurulent and usually are bilateral. • Untreated patient may persist for months and cause corneal and conjunctival scarring .

  9. Diagnosis : • Culture → by conjunctival scrapings • Non culture methods for detection of chlamydial antigens: • Direct fluorescent antibody • Enzyme linked immunosorbent assay (ELISA) • DNA probe • Optical immunoassay (OIA) • Polymerase chain reaction (PCR)

  10. Treatment : • Erythromycin (50 mg/kg/day/qid/2weeks/po) some patient needs second course of treatment. • Ethylsuccinate (50 mg/kg/day/qid/2weeks/po) • Oral erythromycin may causes → infantile hypertrophic pyloric stenosis in infants less than 6 weeks of age.

  11. Topical treatment is unnecessary • Azithromycin (20 mg/kg po) may be effective. • Sulfisoxazole (150 mg/kg/day/qid/po) after neonatal period.

  12. Gonococcal infection • The eye is the most frequent site of gonococcal infection in the newborn. • It causes a purulent conjunctivitis, with profuse exudates and swelling of the eyelids. • Without treatment , it causes blindness. • The incubation period is 2-5 days after birth and it occurs earlier in presence of PROM.

  13. Diagnosis • Newborns who develop conjunctivitis after the first day of age or appear to have severe or persistent chemical conjunctivitis should be evaluated.

  14. Gram stain → conjunctiva exudates for the presence of gram-negative intracellular kidney bean shaped diplococci . • Culture → exudates on Thayer – Martin medium, should be performed. • If organisms are detected, anal and oropharyngeal culture should be obtained . • Co infection with C. trachomatis is common.

  15. Treatment. • Infant should be hospitalized. • Treatment with singele dose of ceftriaxone (25-50 mg/kg/not to exceed 125 mg/Iv or IM). • Topical antibiotic therapy alone is inadequate and is not necessary. • The eyes should be irrigated with saline.

  16. Infants of untreated mothers: • Treatment of symptomatic infants whose mothers have untreated gonococcal infection → single dose of ceftriaxone (25-50 mg/kg/ up to a total dose of 125 mg/Iv or IM) and also should be evaluated for chlamydial infection.

  17. Prevention: • The following are regimens recommended by the AAP. • Silver nitrate (1%) aqueous solution . • Erythromycin (0.5%) ophthalmic ointment. • Tetracycline (1%) ophthalmic ointment. • Povidone – iodine (2.5%) → more effective prophylaxis for chlamydia .

  18. Maternal screening : • Pregnant women should be screened for N. gonorrhoeae and C. trachomatis as part of routine prenatal care. • High-risk women or women without prenatal care should be screened at delivery.

  19. Other localized infection: • Localized infection, such as pharynx, vagina, urethra, and anus can be affected. • Treatment , as in the case of ophtalmia neonaterum (single dose of ceftriaxone 25-50 mg/kg).

  20. Disseminated infection: • Septic arthrits , gonoccal bacteremia and meningitis are rare in the newborn but can be a complication of opthalmia neonatorum.

  21. Culture should be obtained of blood and CSF and from an affected joint. • Treatment for bacteramia and septic arthritis with ceftriaxone (25-50 mg/kg/per dose) IV or IM for 7 days , and 10-14 days for meningitis.

  22. Other bacterial conjunctivitis : • S. aurous • E. coli • Hemophilus influenzae • Pseudomonas aeruginosa

  23. Treatment. • Treatment with local opthalmic ointments (erythromycin or gentamicin) are effective, without complication. • Pseudomonas aeruginosa → require parenteral treatment with an aminoglycosid. + an antipseudomonal penicillin in addition to topical treatment is indicated. • Very severe cases caused by H. influenza may require parenteral treatment.

  24. Nasolacrimal obstructions : • The distal end of the nasolacrimal duct frequently is imperforate at birth. • Subsequent infection → purulent discharge and tearing. • In most cases the infection is alleviated by → opening of the occluded duct by 7 months of age.

  25. Treatment → the opening may occur spontaneously/or → by digital massage over the duct + antibiotic eye drop. • Therapy with ophtalmic ointment may only furthe occlude the duct.

  26. When the symptoms persist beyond 6 – 7 months of age → probing of the duct is indicated → the success rate is > 90% • Persistent obstruction → the probing repeated.

  27. Omphalitis • Omphalitis is characterized by erythema and/or induration of the periumbilical area with purulent discharge and some time foul smelling from the umbilical stump.

  28. Complication • Abdominal wall cellulitis • Necrotizing facities • Peritonitis • Umbilical arthritis/phlebitis • Hepatic vein thrombosis/hepatic abscess

  29. Etiology: • Organisme that are found on the skin . • Or introduced into the umbilical vessel by catheterization. • S. aureus and E. coli are frequent pathogens. • Other bacteria, goroup A streptococci • Anaerobic bacteria .

  30. Diagnosis: • gram-stained and culture of purulent material and a full sepsis evaluation (CBC-BC-LP) .

  31. Treatment : • Otherwise well-appearing infants with → moist or smelly cords without periumbilical erythema edema , or exudate → local treatment .

  32. Infants with periumbilical erythema , edema , and tenderness with or without purulent drainage need parenteral administration of antibiotics . • Oxacillin or nafcillin and gentamicin IV

  33. With serious disease progression → cephalosporin or piperacillin . • The presence of crepitus or black discoloration of the periumbilical tissue caused by anaerobic or mixed infection → adding metronidazole or clindamycin .

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