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neonatal conjunctivitis

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Alternative Names 
ophthalmia neonatorum

Conjunctivitis is an inflammation of the membranes that line the eyelid or the eye. In some cases it is caused by allergies or infections. It can also be brought on by irritants or toxins. Sometimes, another type of illness in the body can cause the problem. When the condition occurs in babies under 4 weeks old, it is called neonatal conjunctivitis.

What is going on in the body? 
The conjunctiva is a mucous membrane that forms the outermost layer of the eye. Any type of irritation to the eye can cause the blood vessels in the conjuntiva to enlarge. This makes the eye appear red. Irritation also causes the eye to produce more tears. In the case of infection, white blood cells and mucous are secreted on the surface of the conjunctiva. This appears as a thick, yellow-green discharge from the eye.

What are the signs and symptoms of the disease? 
Symptoms for the infection are the same for all types of bacteria. Symptoms include:
  • redness and swelling of the conjunctiva
  • swelling of the eyelid
  • discharge from the eye. This may contain pus.
If the infection progresses deeper into the eye, symptoms may include:
  • marked redness of the eye
  • fever
  • severe pain
  • clouding of the cornea
What are the causes and risks of the disease? 
Conjunctivitis in newborns is often caused by bacteria acquired during birth. The baby gets the bacteria from the mother's vagina during delivery. These bacteria often come from a sexually transmitted disease, or STD, carried by the mother. The infection can also be passed if an infant's eyes are touched by an adult whose fingers carry the bacteria.

Conjunctivitis caused by gonorrhoea used to be the leading cause of blindness. It shows up at birth or within the first week afterward. In America, in 1981, doctors began the now common practice of putting silver nitrate in the eyes of newborns. This prevents the infection. If this type of infection develops, prompt treatment is crucial. Severe eye damage can result otherwise. This practice is not common in Australia.

The bacteria that cause chlamydia also cause conjunctivitis in newborns. Chlamydia is the most common STD in Australia. About half of infants born to infected mothers get the eye infection. Symptoms from this type of the disease show up several days to weeks after birth. This type of conjunctivitis infection is not as damaging as one caused by gonorrhoea.

A rare cause of neonatal conjunctivitis is the Pseudomonas aeruginosa bacterium. Since it is generally found in hospital settings, newborns and people hospitalised for serious illnesses are more at risk. This type of conjunctivitis can spread rapidly to the eye itself. It can also get into the infant's bloodstream, leading to infection throughout the body. The result can be shock and death.

Staphlococcus and other bacteria can sometimes cause neonatal conjunctivitis. These infections are similar to those caused by chlamydia.

What can be done to prevent the disease? 
Neonatal conjunctivitis can be prevented by screening and treating pregnant women for STDs. Putting silver nitrate or antibiotic drops in newborns' eyes right after birth helps prevent gonococcal conjunctivitis. Infants born to mothers who have chlamydia infection should be treated with oral antibiotics.

How is the disease diagnosed? 
The doctor can make an initial diagnosis by examining the infant, and order laboratory tests to confirm the diagnosis. gonorrhoea organisms can be detected by looking at eye discharge under a microscope. Scrapings of the conjunctiva must be taken to find chlamydia bacteria. Other bacteria can be found by growing cells from the conjunctiva in the laboratory. Antibody titre tests are also performed in some cases.

What are the long-term effects of the disease? 
Untreated gonococcal conjunctivitis can go deep into the eye, causing permanent scarring and blindness. Infections with pseudomonas can cause similar damage to the eye. This type of infection may also lead to blood stream infection, shock, and death. Infants infected with chlamydia can develop pneumonia.

What are the risks to others? 
Neonatal conjunctivitis can be passed from infant to infant in a nursery. This can happen if caregivers do not wash their hands thoroughly after caring for an infected infant.

What are the treatments for the disease? 
Treatment will depend on the type of infection:
  • Babies born to mothers with Gonorrhoea are given antibiotics right after birth.
  • Babies born to mothers with chlamydia need to take oral antibiotics, such as erythromycin, for 2 weeks.
  • Newborns with gonococcal conjunctivitis need to be hospitalised and treated with an antibiotic called ceftriaxone.
  • Conjunctivitis and pneumonia in newborns caused by chlamydia is treated with 2 weeks of oral erythromycin.
  • Infants with gonococcal or pseudomonas conjunctivitis need their eyes rinsed with saline solution often. This should continue until there is no more eye discharge.
  • Infants with conjunctivitis caused by pseudomonas or staphlococcus should be hospitalised. They are treated with intravenous (IV) antibiotics.
What are the side effects of the treatments? 
The silver nitrate drops put in newborns' eyes to prevent infection can also cause mild irritation. This goes away by itself in a day or two without lasting damage. Topical antibiotics are also used to prevent the infection. These are less likely to cause irritation.

Erythromycin can cause stomach upset and vomiting.

What happens after treatment for the disease? 
After treatment, the conjunctiva will be evaluated for any continued symptoms. If symptoms continue or progress further treatment may be necessary.

How is the disease monitored? 
Babies should be watched to make sure the infection does not return after treatment. Mothers of infants with this disease should be screened for STDs, including: Author: John Wegmann, MD
Reviewer: HealthAnswers Australia Medical Review Panel
Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia
Last Updated: 1/10/2001
Potential conflict of interest information for reviewers available on request

This website and article is not a substitute for independent professional advice. Nothing contained in this website is intended to be used as medical advice and it is not intended to be used to diagnose, treat, cure or prevent any disease, nor should it be used for therapeutic purposes or as a substitute for your own health professional's advice.  All Health and any associated parties do not accept any liability for any injury, loss or damage incurred by use of or reliance on the information.


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