What is Neonatal Conjunctivitis?

Neonatal conjunctivitis or ophthalmia neonatorum is a type of infection that newborns contract during delivery. The newborns contract this infection in cases when the mother is infected with Chlamydia trachomatis or Neisseria gonorrhoeae.

Neonatal conjunctivitis is any type of conjunctivitis that occurs in the first 28 days of baby’s life. In some cases, the infection is viral and is not contracted from the mother. It may also occur as a reaction to some chemical substances, but this type does not last more than 36 hours. Usually it is a self-limiting condition, and it clears without any treatment. This condition is a mild illness, and it should not be a reason to worry or panic. However, in some rare cases, the infection can rapidly progress to corneal damage, which can lead to loss of vision.

Ophthalmia neonatorum affects less than 12% of the infants in the western world, and this number increases up to 25% for infants in developing countries.

Signs and Symptoms

Causes of neonatal conjunctivitis are quite common and are very difficult to differentiate. The conjunctiva is swollen and there's a presence of watery discharge. Chemical conjunctivitis usually makes an appearance between 6 to 8 hours and then lasts for about 2 to 4 days before vanishing. Chlamydial ophthalmia happens 5 to 14 days post birth and can be from mild conjunctivitis, with watery discharge to severely swollen eyelids with continuous discharge. Gonococcal ophthalmia manifests as an acute conjunctivitis that is seen 2 to 5 days post birth or even earlier. There is severe swelling of the eye and excessive watery discharge. If not treated in time, the possibility of corneal trauma and blindness is very likely.

The symptoms of neonatal conjunctivitis can be:

• Mucoid discharge from one or both eyes
• Lid swelling
• Redness in the eyes
• Tearing

Depending on the type of neonatal conjunctivitis, these symptoms may occur between the day of birth and 28 days later.

Chemical conjunctivitis occurs 24 – 48 hours after exposure. This type of conjunctivitis is usually mild one and clears on its own.

Bacterial conjunctivitis has a longer incubation period, and it may occur between the 4th and the 28th day of life. Common types of bacterial neonatal conjunctivitis are a gonorrheal infection that typically occurs 1 to 5 days after birth, and chlamydial infection occurs 5 to 14 days after birth.  

Viral conjunctivitis occurs up to 14 days after birth, and it may present itself with tearing of the eye, mucoid discharge, and even skin lesions.

No matter the type of neonatal conjunctivitis, it usually clears on its own, and the baby should have full recovery even in the worst cases by 12 months of age.

Treatment

Babies who have conjunctivitis and whose mother has a gonococcal infection should be prescribed cefotaxime or ceftriaxone even before the tests have confirmed the infection.

In the case chlamydial ophthalmia, regulated therapy is the best treatment because most of the babies are also infected with nasopharyngeal symptoms and a few get pneumonia. The effectiveness of this treatment is not 100 per cent, so the second course of therapy may well be needed.  Babies who are prescribed erythromycin should be kept under observation for any signs of hypertrophic pyloric stenosis or HPS. Parents of the babies must be warned about the potential risks of HPS.

A baby suffering from gonococcal ophthalmia is admitted into the hospital and evaluated for systemic infection of the type gonococcal. The neonate can be prescribed one dose of ceftriaxone of a maximum 125mg. Those babies with hyperbilirubinemia or the ones who receive fluids containing calcium must not receive ceftriaxone, but instead be given a single dose of cefotaxime of 100mg/kg either intravenously or intramuscularly. The eye can frequently be administered a saline solution to prevent it from sticking. The anti-microbial ointment is ineffective and unnecessary when the treatment is ongoing. When other kinds of bacteria cause conjunctivitis, topical ointments containing tetracycline, bacitracin, or erythromycin can be prescribed.

Ophthalmia neonatorum caused by herpes

Babies who are thought to have contracted conjunctivitis because of the herpes simplex virus must be prescribed Acyclovir or Vidarabine for a minimum of 2 weeks to stop the spread of the infection. Eye drops or ointment can also be prescribed as a topical treatment.

Conclusion

Pregnant women should be made aware of the implications and necessity of routine screening. This will give her and her baby much better health care. Any infection present in the mother and treated before she gives birth will reduce the chances of the disease passing on to her child. It will also minimise the chances of the baby developing childhood blindness in countries around the world.

The prevention of neonatal conjunctivitis usually relates to the mother. The mother should always take good care of herself and keep her hygiene on the highest levels. In cases when the mother has a chlamydial or gonorrheal infection, she should use solutions made of 2% silver nitrate. This treatment may prevent conjunctivitis, but it is also not guaranteed. More than 60% of babies contract conjunctivitis if the mother has it - no matter the treatment.

In cases when the neonatal conjunctivitis does not clear on its own, it is recommended for the baby to take antibiotics that are prescribed by a specialist. It is really important for the mother not to treat the baby on her own, because even though conjunctivitis can be treated with holistic treatments, when it comes to adults, those treatments are rarely recommended for infants. There may be a lot of things that the baby is allergic to without the mother knowing and if the mother decides to treat the baby on her own, she may do more damage than good.

Neonatal conjunctivitis is a common infection in infants, so it should not be a reason for panic. Nevertheless, the mother must consult with a specialist about the treatment and if she herself has some form of conjunctivitis. She must take all the necessary measures to make sure that she is also treated because conjunctivitis is contagious, and the baby may contract it again if the mother does not clear herself from the infection.