OPHTHALMOLOGY
NEONATAL CONJUCTIVITIS
? move to paeds
PromptPathogens include staphylococcus, haemophilus, streptococcus, chlamydia, gonococcus and herpes simplex
Consider gonococcal conjunctivitis if severe purulent discharge with conjunctival and lid oedema
Gonococcal ophthalmia neonatorum with swelling, purulent discharge, injection of the conjunctiva and chemosis
Consider gonococcal conjunctivitis if severe purulent discharge with conjunctival and lid oedema
Gonococcal ophthalmia neonatorum with swelling, purulent discharge, injection of the conjunctiva and chemosis
Response
- Obtain conjunctival swabs for gram stain, giemsa stain and cultures, and gonococcal and chlamydia PCR if clinical suspicion
- Gonococcus, chlamydia and herpes simplex can cause invasive disease and may require septic work up. Seek specialist advice (eg neonatology, infectious diseases, general paediatrics, ophthalmology). See Recognition of the seriously unwell neonate
- Treat chlamydial conjunctivitis with oral azithromycin 20mg/kg once daily for 3 days and eye toilet
- Treat gonococcal conjunctivitis with a stat dose of ceftriaxone 25-50mg/kg. Where possible, ceftriaxone should be avoided in neonates <41 weeks gestation, particularly if jaundiced or receiving calcium containing solutions. See Antimicrobial guidelines
- Herpes simplex infection and/or keratitis is likely to require septic work up and treatment with IV aciclovir. Seek specialist advice
- Treat other organisms with topical chloramphenicol 0.5% eye drops 4–6 times per day for 5–7 days