Treatment and Prevention of Ophthalmia Neonatorum

Overview

• Ophthalmia Neonatorum (ON): An acute mucopurulent infection occurring in the first 4 weeks of life, affecting 1.6% to 12% of newborns.
• Causes: Chemical, bacterial, or viral.
• Historical Context: Before the 1880s, ON was a primary cause of neonatal blindness.

Prophylaxis and Treatment

Prophylaxis

• Recommendation: All infants should receive ocular prophylaxis at birth to prevent gonococcal ophthalmia.
• Substances Used: 1% silver nitrate, 0.5% erythromycin ointment, or 1% tetracycline hydrochloride.

Diagnosis and Initial Steps

• Neonates with conjunctivitis should have a conjunctival swab for Gram stain and culture.
• If Gram-negative diplococci are found, treat for gonorrhea immediately.

Treatment Approaches

• Topical antibiotics: Suitable for most bacterial conjunctivitis except Pseudomonas.
• Systemic antibiotics: Required for chlamydial infections and severe cases.

Causes of Ophthalmia Neonatorum

Chemical Conjunctivitis

• Causes: Linked to silver nitrate, erythromycin, or tetracycline prophylaxis.
• Characteristics: Mild, purulent; self-limiting.

Bacterial Causes

• Non-sexually transmitted bacteria: Accounts for 30%-50% of ON cases.
  • Organisms: Staphylococcus aureus, Streptococcus pneumoniae, Escherichia coli, etc.
• Sexually Transmitted Bacteria:
  • Chlamydia trachomatis: Accounts for up to 40% of cases in Canada.
  • Neisseria gonorrhoeae: Rare but requires immediate intervention.

Viral Causes

• Common Viruses: Adenovirus, herpes simplex virus.
• Characteristics: Often has associated lymphadenopathy.

Specific Infections and Management

Chlamydial Infections

• Risk: 50%-75% transmission from infected mothers.
• Symptoms: Range from mild conjunctival injection to severe mucopurulent discharge.
• Treatment: 14-day course of systemic erythromycin.

Gonococcal Infections

• Transmission Rate: 30%-42% without prophylaxis.
• Symptoms: Profound chemosis, eyelid edema, and purulent discharge.
• Treatment: Hospitalization, frequent irrigation, and ceftriaxone administration.

Herpes Simplex Virus

• Symptoms: Herpetic lesions on eyelid borders appear 6-14 days post-birth.
• Treatment: Systemic acyclovir and topical ophthalmic solutions.

Preventive Guidelines

• Canadian Guidelines: Support ocular prophylaxis for all newborns to prevent sight-threatening infections.
• Limitations: Routine prophylaxis does not prevent chlamydial ON.

Child Health Update (PRETx)

• Produced by Pediatric Research in Emergency Therapeutics at BC Children's Hospital.
• Mission: Promote child health through research in pediatric emergency medicine.

Conclusion

• Continued vigilance and prophylaxis are essential in managing and preventing ON.
• Specialized treatment is necessary depending on the bacterial or viral agent involved.